Emergency department outcomes of children with non-typhoidal Salmonella gastroenteritis: a single-center cohort study with adult comparators
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Purpose: This study was performed to compare clinical features and emergency department (ED) outcomes between children and adults with non-typhoidal Salmonella (NTS) gastroenteritis in a single-center cohort. Methods: We retrospectively reviewed electronic medical records of ED patients with stool multiplex polymerase chain reaction-confirmed NTS at CHA Bundang Medical Center from January 2016 through December 2021. Demographics, presentation, laboratory and imaging findings, microbiology, and treatments were abstracted. Primary outcomes were the high acuity (a Korean Triage and Acuity Scale level 1-2), ED length of stay, and disposition. Results: Of 189 patients, 134 were children and 55 adults. The children had fewer comorbidities (children, 5.2% vs. adults, 56.4%; P < 0.001) and high acuity (0% vs. 14.5%), shorter median ED length of stay (237.0 minutes [interquartile range, 188.0-336.0] vs. 360.0 minutes [335.0-569.0]; difference, 123.0 minutes [95% confidence interval, 85.0- 328.0]; P < 0.001), and less frequent hospitalizations to the intensive care unit (0% vs. 14.5%; P < 0.001). Fever (94.8% vs. 63.6%) and hematochezia (37.3% vs. 0%) were more common in the children (Ps < 0.001), while adults had higher frequencies of abdominal pain (87.3% vs. 71.6%; P = 0.020) and enteritis/ileus on radiography (63.3% vs. 45.3%; P = 0.033), and higher median values of segmented white blood cells (79.0% vs. 69.4%; P = 0.010) and C-reactive protein concentration (7.2 vs. 6.3 mg/dL; P < 0.001). Ceftriaxone was more commonly used in the children (72.7% vs. 51.9%; P < 0.001). Conclusion: Compared with the adults, the children with NTS gastroenteritis presented with lower clinical acuity, shorter ED stays, and no hospitalizations to the intensive care unit, despite more common fever and hematochezia. These findings may support a conservative ED approach in children with careful, indication-based antibiotic use and highlight opportunities for antimicrobial stewardship.
Abstract
Purpose: This study was performed to compare clinical features and emergency department (ED) outcomes between children and adults with non-typhoidal Salmonella (NTS) gastroenteritis in a single-center cohort. Methods: We retrospectively reviewed electronic medical records of ED patients with stool multiplex polymerase chain reaction-confirmed NTS at CHA Bundang Medical Center from January 2016 through December 2021. Demographics, presentation, laboratory and imaging findings, microbiology, and treatments were abstracted. Primary outcomes were the high acuity (a Korean Triage and Acuity Scale level 1-2), ED length of stay, and disposition. Results: Of 189 patients, 134 were children and 55 adults. The children had fewer comorbidities (children, 5.2% vs. adults, 56.4%; P < 0.001) and high acuity (0% vs. 14.5%), shorter median ED length of stay (237.0 minutes [interquartile range, 188.0-336.0] vs. 360.0 minutes [335.0-569.0]; difference, 123.0 minutes [95% confidence interval, 85.0- 328.0]; P < 0.001), and less frequent hospitalizations to the intensive care unit (0% vs. 14.5%; P < 0.001). Fever (94.8% vs. 63.6%) and hematochezia (37.3% vs. 0%) were more common in the children (Ps < 0.001), while adults had higher frequencies of abdominal pain (87.3% vs. 71.6%; P = 0.020) and enteritis/ileus on radiography (63.3% vs. 45.3%; P = 0.033), and higher median values of segmented white blood cells (79.0% vs. 69.4%; P = 0.010) and C-reactive protein concentration (7.2 vs. 6.3 mg/dL; P < 0.001). Ceftriaxone was more commonly used in the children (72.7% vs. 51.9%; P < 0.001). Conclusion: Compared with the adults, the children with NTS gastroenteritis presented with lower clinical acuity, shorter ED stays, and no hospitalizations to the intensive care unit, despite more common fever and hematochezia. These findings may support a conservative ED approach in children with careful, indication-based antibiotic use and highlight opportunities for antimicrobial stewardship.