Management of acute diarrhea in the emergency department of a tertiary care university medical center

Abstract

Objectives To examine the management of acute diarrhea in the emergency department (ED) of a large university medical center. Methods Retrospective cross-sectional study over a 10-month period of adult patients (age ≥18 years) presenting to the ED with acute diarrhea. Results Data for 780 patients were reviewed; 101 met the exclusion criteria. Of the 679 patients with acute community-acquired diarrhea, 582 (85.7%) were discharged home and constituted the study cohort of mostly healthy adults (mean age: 32.5 ± 14.5 years). The rate of antibiotic prescription at discharge was 26%. Inappropriate use of antibiotics occurred in 28% of the patients. The presence of fever (odds ratio (OR) = 3.52), leukocytosis (OR = 1.72), and older age (OR = 1.16) were predictors of antibiotic prescription. Patients with dehydration, comorbidities, or bloody diarrhea were more likely to receive antibiotics. Microbiological studies and cross-sectional imaging were ordered in 12.4% and 11.7% of the patients, respectively, but provided very low yield (<10% for both) resulting in significantly higher visit charges. Inappropriately prescribed antibiotics at discharge resulted in higher charges in the ED compared with no antibiotic prescription. Conclusion Acute diarrhea management in our ED is suboptimal and does not adhere to practice guidelines, resulting in unnecessary antibiotic prescriptions, investigations, and cost.