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Table 5 Recommendations on diagnosis and treatment based on consensus.

From: Guidelines on acute gastroenteritis in children: a critical appraisal of their quality and applicability in primary care

  Guidelines  
  ARM CDC ESP CPS WGO NHG CCH NICE  
AGREE domain score 'rigour of development' (%) 88.1 35.7 90.5 38.1 28.6 66.7 85.7 88.1  
GP in guideline development team? No No No No No Yes No Yes  
DIAGNOSIS Consistent yes/no
Patients should be seen by physician if:   $ $    $   $ n = 4 #
They have risk factors for dehydration:          
Young age   + +      + Y•
Low birth weight/premature birth   +       + N
Fever   +     +    N
Stopped breastfeeding         + N
High output*   + +    +   + Y•
Persistent vomiting/>2 vomits per 24 h   + +      + Y•
Signs of malnutrition         + N
Reported signs of severe dehydration   +     +   + Y•
Fluid losses exceed intake       +    N
Not offered/able to tolerate supplemented fluids/suboptimal response   +       + N
Signs of severe cause for diarrhea/underlying disease   + +    +   + Y•
Family circumstances   +       + N
Blood tests and stool cultures $ $ $   $ $ $ $ n = 7 #
Should not be routinely performed + + +   + + + + Y•
Perform stool culture if: $ $ $   $ $   $ n = 6 #
Dehydrated or febrile patients      +     N
Sick patients with dysentery ¥ + + +    +   + Y•
Blood/pus in stool +     +     N
Immuno-compromised patients    +    +   + Y•
Patients with high infectivity for others       +    N
In case of outbreak    +       N
Recently traveled abroad +      +   + Y•
To verify another etiology/uncertain diagnosis/if no improvement after 7 days    +      + N
MANAGEMENT
Refer/admit to hospital if $ $ $   $ $   $ n = 6 #
Social/logistic concerns + + +   + +   + Y•
Failure of initial rehydration + + +   + +   + Y•
Suspected alternative serious diagnosis + + +   + +   + Y•
Shock/severe dehydration   + +   + +    Y•
High risk of dehydration   + +    +    N
Intractable/persistent vomiting   +        N
Vomiting   $   $   $    n = 3 #
is not a contraindication for ORS   +   +   +    Y•
Do not give ORS if protracted vomiting despite small frequent feeding     +      N
  1. § : Guidelines making a recommendation on this subject
  2. * = > 6 diarrheal stool in 24 h, or > 3 vomits in 24 h or watery diarrhea > 6 times a day > 3 days (<2 years: > 1 day)
  3. ¥ Dysentery = diarrhea with mucus and/or blood in stool, with fever and abdominal pain
  4. # = number of guidelines making a recommendation on this subject
  5. + = recommended
  6. • = a general practitioner was present in at least one guideline production
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BMC Primary Care

ISSN: 2731-4553

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