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## Complete Summary

#### GUIDELINE TITLE

Evidence-based clinical care guideline for acute gastroenteritis (AGE)
in children aged 2 months through 5 years.

#### BIBLIOGRAPHIC SOURCE(S)

Cincinnati Children\'s Hospital Medical Center. Evidence-based clinical
care guideline for acute gastroenteritis (AGE) in children aged 2 months
through 5 years. Cincinnati (OH): Cincinnati Children\'s Hospital
Medical Center; 2006 May. 15 p. \[50 references\]

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Cincinnati Children\'s
Hospital Medical Center. Evidence based clinical practice guideline for
children with acute gastroenteritis (AGE). Cincinnati (OH): Cincinnati
Children\'s Hospital Medical Center; 2001 Apr. 13 p.

The guideline was reviewed for currency in May 2006, using updated
literature searches and was determined to be current.

### COMPLETE SUMMARY CONTENT

 SCOPE\
 METHODOLOGY - including Rating Scheme and Cost Analysis\
 RECOMMENDATIONS\
 EVIDENCE SUPPORTING THE RECOMMENDATIONS\
 BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS\
 CONTRAINDICATIONS\
 QUALIFYING STATEMENTS\
 IMPLEMENTATION OF THE GUIDELINE\
 INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT
CATEGORIES\
 IDENTIFYING INFORMATION AND AVAILABILITY\
 DISCLAIMER

### SCOPE

#### DISEASE/CONDITION(S)

Acute gastroenteritis

#### GUIDELINE CATEGORY

Evaluation\
Management

#### CLINICAL SPECIALTY

Emergency Medicine\
Family Practice\
Pediatrics

#### INTENDED USERS

Advanced Practice Nurses\
Dietitians\
Nurses\
Patients\
Physician Assistants\
Physicians

#### GUIDELINE OBJECTIVE(S)

To help practitioners at all levels of experience refine their knowledge
and select among the options for evaluation and management of children
with acute gastroenteritis based on the most current and best scientific
information

In the target population, the objectives of this guideline are to:

-   Improve the use of appropriate clinical and laboratory assessment

-   Increase the use of oral rehydration and early progression to usual
    diet

-   Improve parental involvement in decision making around the
    management of acute gastroenteritis (AGE)

-   Improve prevention of transmission of acute gastroenteritis

-   Decrease use of emergency department (ED) services for management of
    mild cases

-   Reduce the number of hospitalizations

-   Reduce the length of stay

#### TARGET POPULATION

Children aged 2 months to 5 years of age with signs and symptoms of
acute gastroenteritis (diarrhea of recent onset not caused by chronic
disease) with or without accompanying nausea, vomiting, fever, or
abdominal pain.

These guidelines do NOT address all considerations needed to manage
those with the following:

-   Toxic appearance or requiring intensive care

-   Episodes of diarrhea lasting longer than 7 days

-   Previously diagnosed disorders including immunodeficiency or those
    affecting major organ systems

-   Vomiting with no accompanying diarrhea

-   Acute gastroenteritis accompanying failure to thrive

-   Diarrhea and/or vomiting accompanied by chronic metabolic disorders
    (e.g., diabetes, phenylketonuria \[PKU\])

-   Diagnosis of hyponatremic or hypernatremic dehydration

#### INTERVENTIONS AND PRACTICES CONSIDERED

**Evaluation**

1.  History and physical examination

2.  Assessment of degree of dehydration

3.  Laboratory studies (not routinely recommended)

**Management**

1.  Usual diet

2.  Small frequent feedings

3.  Oral rehydration therapy solutions (ORS)

4.  Intravenous (IV) therapy

5.  Nasogastric oral rehydration solutions

6.  Prompt refeeding of regular diet after rehydration

7.  Antimicrobial therapy for selected children

8.  Probiotics as adjunctive therapy

9.  Hospitalization

10. Reassessment of hydration status

11. Patient/parent education

**Note**: Anti-diarrheal agents and anti-emetics are considered but not
recommended.

#### MAJOR OUTCOMES CONSIDERED

-   The severity of dehydration

-   The need for intravenous or nasogastric (NG) therapies

-   Hospitalization rate

-   The duration of illness and length of hospitalization

### METHODOLOGY

#### METHODS USED TO COLLECT/SELECT EVIDENCE

Searches of Electronic Databases

#### DESCRIPTION OF METHODS USED TO COLLECT/SELECT THE EVIDENCE

To select evidence for critical appraisal by the group for the update of
this guideline, the Medline, EmBase, and the Cochrane databases were
searched for dates of January 2000 to March 2003 to generate an
unrefined, \"combined evidence\" database using a search strategy
focused on answering clinical questions relevant to acute
gastroenteritis (AGE) and employing a combination of Boolean searching
on human-indexed thesaurus terms (Medical Subject Heading \[MeSH}
headings using an OVID Medline interface) and \"natural language\"
searching on searching on human-indexed thesaurus terms (MeSH headings
using an OVID Medline interface) and \"natural language\" searching on
words in the title, abstract, and indexing terms. The citations were
reduced by eliminating duplicates, review articles, non-English
articles, and adult articles. The resulting abstracts were reviewed by a
methodologist to eliminate low quality and irrelevant citations. During
the course of the guideline development, additional clinical questions
were generated and subjected to the search process, and some relevant
review articles were identified. December 1999 was the last date for
which literature was reviewed for the previous version of this
guideline. The details of that review strategy are not documented.
However, all previous citations were reviewed for appropriateness to
this revision.

**May 2006 Review**

A search using the above criteria was conducted for dates of January,
2004 through May, 2006. Thirty-three relevant articles were selected as
potential future citations for the guideline. However, none of these
references were determined to require changes to the 2005 version of the
recommendations.

#### NUMBER OF SOURCE DOCUMENTS

99

#### METHODS USED TO ASSESS THE QUALITY AND STRENGTH OF THE EVIDENCE

Not stated

#### RATING SCHEME FOR THE STRENGTH OF THE EVIDENCE

Not applicable

#### METHODS USED TO ANALYZE THE EVIDENCE

Review of Published Meta-Analyses\
Systematic Review

#### DESCRIPTION OF THE METHODS USED TO ANALYZE THE EVIDENCE

Not stated

#### METHODS USED TO FORMULATE THE RECOMMENDATIONS

Expert Consensus

#### DESCRIPTION OF METHODS USED TO FORMULATE THE RECOMMENDATIONS

Recommendations have been formulated by a consensus process directed by
best evidence, patient and family preference and clinical expertise.
During formulation of these guidelines, the committee members have
remained cognizant of controversies and disagreements over the
management of these patients. They have tried to resolve controversial
issues where possible and, when not possible, to offer optional
approaches to care in the form of information that includes best
supporting evidence of efficacy for alternative choices.

#### RATING SCHEME FOR THE STRENGTH OF THE RECOMMENDATIONS

Not applicable

#### COST ANALYSIS

A formal cost analysis was not performed and published cost analyses
were not reviewed.

#### METHOD OF GUIDELINE VALIDATION

External Peer Review\
Internal Peer Review

#### DESCRIPTION OF METHOD OF GUIDELINE VALIDATION

Experience with the implementation of earlier publications of this
guideline has provided learnings that have been incorporated into this
revision. The guidelines have been reviewed and approved by clinical
experts not involved in the development process, senior management, Risk
Management & Corporate Compliance, other appropriate hospital
committees, and other individuals as appropriate to their intended
purposes.

### RECOMMENDATIONS

#### MAJOR RECOMMENDATIONS

Each recommendation is followed by evidence classification (A-X)
identifying the type of supporting evidence. Definitions for the types
of evidence are presented at the end of the \"Major Recommendations\"
field.

**Assessment and Diagnosis**

**Clinical Assessment**

1.  It is recommended that the history and physical examination be the
    primary basis for the diagnosis of acute gastroenteritis (AGE). See
    Figure and Appendix 1 in the original guideline document (Local
    Expert Consensus, 2005 \[E\]).

2.  It is recommended that clinical assessment be initially performed
    for the presence and degree of dehydration (Steiner, DeWalt, &
    Byerley, 2004 \[M\]). See Appendix 2 in the original guideline
    document for physical parameters associated with degree of
    dehydration. See Table 2 and Table 3 in the original guideline
    document for likelihood ratios of clinical signs.

> **Note 1**: Prolonged capillary refill time, abnormal skin turgor, and
> absent tears are the best individual examination measures (Steiner,
> DeWalt, & Byerley, 2004 \[M\]) (see Table 2, Table 3, and Appendix 2
> in the original guideline document).
>
> **Note 2**: Clinical diagnosis of dehydration has been shown to be
> imprecise and thus a general classification of a child\'s dehydration
> status such as none, some (mild/moderate), or severe is suggested by
> the literature as a useful starting point in the management of the
> child at risk for dehydration (Steiner, DeWalt, & Byerley, 2004 \[M\];
> King et al., 2003 \[S, E\]).
>
> **Note 3**: Acute body weight change is considered the gold standard
> measure of dehydration in a child but is often impractical for the
> initial assessment due to lack of an accurate pre-illness weight
> measurement (Gorelick, Shaw, & Murphy, 1997 \[C\]; Duggan et al., 1996
> \[C\]).

**Laboratory Studies**

3.  It is recommended that laboratory tests not be routinely performed
    in children with signs and symptoms of AGE, including tests for
    specific pathogens, such as those for rotavirus, ova and parasites,
    bacteria, and fecal antigen tests for parasites (Northrup &
    Flanigan, 1994 \[S\]; Local Expert Consensus, 2005 \[E\]).

> **Note**: Serum electrolytes are sometimes useful in assessing
> children with moderate to severe dehydration and who require
> intravenous (IV) or nasogastric (NG) fluids. A normal bicarbonate
> concentration may be useful in ruling out dehydration (Steiner, DeWalt
> & Byerley, 2004 \[M\]).

**Management Recommendations**

**Prevention of Dehydration**

4.  It is recommended that continued use of the child\'s preferred,
    usual, and age appropriate diet be encouraged to prevent or limit
    dehydration (Brown, Peerson, & Fontaine, 1994 \[M\]; Fayad et al.,
    1993 \[A\]; Alarcon et al., 1992 \[A\]). Regular diets are generally
    more effective than restricted and progressive diets, and in
    numerous trials have consistently produced a reduction in the
    duration of diarrhea (Alarcon et al., 1991 \[A\]; Margolis et al.,
    1990 \[B\]; Placzek & Walker-Smith, 1984 \[B\]; Khin et al., 1985
    \[C\]).

> **Note 1**: The historical BRAT diet (consisting of bananas, rice,
> applesauce, and toast) is unnecessarily restrictive, but may be
> offered as part of the child\'s usual diet (King et al., 2003
> \[S,E\]).
>
> **Note 2**: Clear liquids are not recommended as a substitute for oral
> rehydration solutions (ORS) or regular diets in the prevention or
> therapy of dehydration (King et al., 2003 \[S,E\]) (See Appendix 4 in
> the original guideline document).
>
> **Note 3**: The vast majority of patients with AGE do not develop
> clinically important lactose intolerance. In selected patients with
> documented, persistent lactose intolerance, lactose-free formulas are
> recommended (Brown, Peerson, & Fontaine, 1994 \[M\]).
>
> **Note 4**: A meta-analysis of 16 studies found no significant
> clinical advantage to diluting milk or formula in the management of
> AGE (Brown, Peerson, & Fontaine, 1994 \[M\]).

5.  It is recommended that the vomiting child be offered frequent small
    feedings (every 10 to 60 minutes) of any tolerated foods or ORS (Wan
    et al., 1999 \[A\]; Santosham et al., 1985 \[A\]).

6.  It is recommended that a child with recurrent vomiting but no signs
    of significant dehydration may be managed by frequent telephone
    follow up or by direct supervision in the office, emergency
    department, or in a hospital setting (see Appendix 1 in the original
    guideline document for triage suggestions) (Local Expert Consensus,
    2005 \[E\]).

**Rehydration**

7.  It is recommended that dehydration be treated with ORS, if tolerated
    and if intake exceeds losses, for a period of 4 to 6 hours or until
    an adequate degree of rehydration is achieved (Gavin, Merrick, &
    Davidson, 1996 \[M\]; Gore, Fontaine, & Pierce, 1992 \[M\]; Cohen et
    al., 1995 \[A\]; Molina et al., 1995 \[A\]; Fayad et al., 1993
    \[A\]; Santosham et al., 1985 \[A\]; Santosham et al., 1982 \[A\];
    Atherly-John, Cunningham, & Crain, 2002 \[B\]; Nager & Wang, 2002
    \[B\]; Listernick, Zieserl, & Davis, 1986 \[B\]; Tamer et al., 1985
    \[C\]; King et al., 2003 \[S,E\]; Holliday, 1996 \[S,E\]).

8.  It is recommended

    -   when unable to replace the estimated fluid deficit and keep up
        with the on-going losses using oral feedings alone, and/or

    -   for severely dehydrated children with obtunded mental status

> that IV fluids or NG ORS be given for a period of 4 to 6 hours or
> until an adequate degree of rehydration is achieved. It is appropriate
> to involve the family in the decision regarding the method of fluid
> replacement (Cohen et al., 1995 \[A\]; Mackenzie & Barnes, 1991 \[A\];
> Santosham et al., 1982 \[A\]; Nager & Wang, 2002 \[B\]; Vesikari,
> Isolauri, & Baer, 1987 \[B\]; Listernick, Zieserl, & Davis, 1986
> \[B\]; Tamer et al., 1985 \[C\]; King et al., 2003 \[S,E\]).

**Oral Feeding Following Rehydration**

9.  It is recommended that refeeding of the usual diet be started at the
    earliest opportunity after an adequate degree of rehydration is
    achieved (Cohen et al., 1995 \[A\]; Fayad et al., 1993 A\];
    Santosham et al., 1982 \[A\]; Fox et al., 1990 \[B\]; Hjelt et al.,
    1989 \[B\]; Gazala et al., 1988 \[B\]; Walker-Smith et al., 1997
    \[S,E\]).

> **Note 1**: Following rehydration therapy in the child with mild to
> moderate dehydration, regular diets may be supplemented with oral
> rehydration solutions containing at least 45 mEq Na^+^/L, and targeted
> to deliver 10mL/kg for each stool or emesis (Cohen et al., 1995 \[A\])
> (see Appendix 4 in the original guideline document).
>
> **Note 2**: It is advisable to reassess hydration status by phone or
> in the office when a child refuses ORS. Refusal may indicate an
> absence of salt craving, and, as such, the absence or resolution of
> dehydration (Local expert Consensus, 2005 \[E\]).

**On-going IV or NG Fluids following Rehydration**

10. It is recommended that maintenance IV fluids or NG ORS be given:

    -   when unable to replace the estimated fluid deficit and keep up
        with the on-going losses using oral feedings alone, and/or

    -   to severely dehydrated children with obtunded mental status, and
        after discussion with family regarding choice of IV or NG (Cohen
        et al., 1995 \[A\]; Mackenzie & Barnes, 1991 \[A\]; Santosham et
        al., 1982 \[A\]; Nager & Wang, 2002 \[B\]; Vesikari, Isolauri, &
        Baer, 1987 \[B\]; Listernick, Zieserl, & Davis, 1986 \[B\];
        Tamer et al., 1985 \[C\]).

**Other Therapy**

11. It is recommended that anti-diarrheal agents or antiemetics not be
    used in the routine management of children with AGE (King et al.,
    2003 \[S,E\]).

> **Note**: Ondansetron may decrease vomiting and hospitalization rates
> in those patients who require IV or NG fluids (Reeves, Shannon, &
> Fleisher, 2002 \[A\]; Ramsook et al., 2002 \[B\]).

12. It is recommended that antimicrobial therapies be used only for
    selected children with AGE who present with special risks or
    evidence of a serious bacterial infection (SBI) (Barbara et al.,
    2000 \[C\]) (see Appendix 5 in the original guideline document).

> **Note**: *Giardia lamblia* and *Cryptosporidium* are common causes of
> persistent diarrhea and, if found, treatment is available with
> metronidazole or nitazoxanide (American Academy of Pediatrics, 2003
> \[O\]).

13. It is recommended that probiotics be considered as adjunctive
    therapy, as they have been shown to reduce the duration of diarrhea
    (Allen et al., 2004 \[M\]). Family preference may be central to the
    decision to use probiotics. Parameters influencing the family\'s
    decision may include cost, degree of potential benefit,
    availability, and unverified effectiveness of commercial products.

> **Note 1**: A Cochrane meta-analysis of 23 randomized controlled
> trials found mild therapeutic benefit from probiotics that was
> generally reproducible regardless of organism, quality of study
> design, or outcome measure (Allen et al., 2004 \[M\]). The following
> organisms/combinations showed benefit in one or more study (in
> alphabetical order):

-   *Enterococcus LAB strain SF68*

-   *Lactobacillus acidophilus* and *Lactobacillus bifidus*

-   *Lactobacillus acidophilus LB strain* (killed)

-   *Lactobacillus casei strain GG*

-   *Lactobacillus reuteri*

> **Note 2**: Probiotics may be more effective for rotavirus diarrhea,
> compared to all-cause diarrhea (Allen et al., 2004 \[M\]).
>
> **Note 3**: The microorganisms used to culture yogurt, *Streptococcus
> thermophilus* and *Lactobacillus bulgaricus*, are not considered
> probiotics because they do not survive the acidity of the stomach to
> colonize the intestines. One study of malnourished infants found that
> yogurt, compared to milk, was not effective in reducing the duration
> of diarrhea (Allen et al., 2004 \[M\]; Bhatnagar et al., 1998 \[B\]).

**Inpatient Management Considerations**

14. It is recommended that those patients who are treated in the
    hospital setting and who are eligible for the AGE guideline be
    placed as Short Stay patients with a discharge goal of 23 hours or
    less (Browne & Penna, 1996 \[C\]; McConnochie et al., 1999 \[D\]).

15. It is recommended that for children receiving care in a hospital
    setting, prompt discharge be considered when the following levels of
    recovery are reached:

    -   Sufficient rehydration achieved as indicated by weight gain
        and/or clinical status

    -   IV or NG fluids not required

    -   Oral intake equals or exceeds losses

    -   Adequate family teaching has occurred

    -   Medical follow up is available via telephone or office visit

> (Local Expert Consensus, 2005 \[E\]).

**Education**

16. It is recommended that return to school/daycare be discussed in the
    context of the following parameters:

    -   Consideration for controlling disease transmission

        -   No vomiting for 24 hours

        -   Stools are able to be adequately contained

        -   Assurance that daycare/school adheres to appropriate
            handwashing policies

    -   Temperature less than 38.0 degrees C (100.4 degrees F)

> (Local Expert Consensus, 2005 \[E\]).

17. It is recommended that risk factors and preventive activities be
    discussed with parents, including:

    -   Continue breastfeeding (Wan et al., 1999 \[A\]; Khin et al.,
        1985 \[C\])

    -   Handwashing

**Definitions**:

**Evidence Grading Scale**:

A: Randomized controlled trial: large sample\
B: Randomized controlled trial: small sample\
C: Prospective trial or large case series\
D: Retrospective analysis\
E: Expert opinion or consensus\
F: Basic laboratory research\
S: Review article\
M: Meta-analysis\
Q: Decision analysis\
L: Legal requirement\
O: Other evidence\
X: No evidence

#### CLINICAL ALGORITHM(S)

Algorithms are provided in the original guideline document for:

-   The evaluation and management for acute gastroenteritis in children
    aged 2 months through 5 years

-   A decision tool for helping decide when to obtain stool cultures and
    when a child may benefit from antimicrobial therapies

### EVIDENCE SUPPORTING THE RECOMMENDATIONS

#### REFERENCES SUPPORTING THE RECOMMENDATIONS

[References open in a new
window](http://www.guideline.gov/summary/select_ref.aspx?doc_id=9529)

#### TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence is classified for the recommendations (see \"Major
Recommendations\").

**Evidence Grading Scale**:

A: Randomized controlled trial: large sample\
B: Randomized controlled trial: small sample\
C: Prospective trial or large case series\
D: Retrospective analysis\
E: Expert opinion or consensus\
F: Basic laboratory research\
S: Review article\
M: Meta-analysis\
Q: Decision analysis\
L: Legal requirement\
O: Other evidence\
X: No evidence

### BENEFITS/HARMS OF IMPLEMENTING THE GUIDELINE RECOMMENDATIONS

#### POTENTIAL BENEFITS

-   Prevention or limitation of the severity of dehydration

-   Prevention of the need for intravenous or nasogastric therapies

-   Decreased hospitalization rate

-   Shortened duration of illness and length of hospitalization

#### POTENTIAL HARMS

Not stated

### CONTRAINDICATIONS

#### CONTRAINDICATIONS

Antibiotics are contraindicated for the treatment of enterohemorrhagic
*Escherichia coli* (O157:H7) as they increase the likelihood of
hemolytic uremic syndrome.

### QUALIFYING STATEMENTS

#### QUALIFYING STATEMENTS

These recommendations result from review of literature and practices
current at the time of their formulations. This protocol does not
preclude using care modalities proven efficacious in studies published
subsequent to the current revision of this document. The guideline
document is not intended to impose standards of care preventing
selective variances from the guidelines to meet the specific and unique
requirements of individual patients. Adherence to this pathway is
voluntary. The physician in light of the individual circumstances
presented by the patient must make the ultimate judgment regarding the
priority of any specific procedure.

### IMPLEMENTATION OF THE GUIDELINE

#### DESCRIPTION OF IMPLEMENTATION STRATEGY

Appropriate companion documents have been developed to assist in the
effective dissemination and implementation of the guideline.

#### IMPLEMENTATION TOOLS

Chart Documentation/Checklists/Forms\
Clinical Algorithm\
Foreign Language Translations\
Patient Resources\
Quick Reference Guides/Physician Guides

For information about
[availability](#identifying-information-and-availability), see the
\"Availability of Companion Documents\" and \"Patient Resources\" fields
below.

### INSTITUTE OF MEDICINE (IOM) NATIONAL HEALTHCARE QUALITY REPORT CATEGORIES

#### IOM CARE NEED

Getting Better

#### IOM DOMAIN

Effectiveness\
Patient-centeredness

### IDENTIFYING INFORMATION AND AVAILABILITY

#### BIBLIOGRAPHIC SOURCE(S)

Cincinnati Children\'s Hospital Medical Center. Evidence-based clinical
care guideline for acute gastroenteritis (AGE) in children aged 2 months
through 5 years. Cincinnati (OH): Cincinnati Children\'s Hospital
Medical Center; 2006 May. 15 p. \[50 references\]

#### ADAPTATION

Not applicable: The guideline was not adapted from another source.

#### DATE RELEASED

1999 Nov (revised 2005 Oct 31; reviewed 2006 May)

#### GUIDELINE DEVELOPER(S)

Cincinnati Children\'s Hospital Medical Center - Hospital/Medical Center

#### SOURCE(S) OF FUNDING

Cincinnati Children\'s Hospital Medical Center

#### GUIDELINE COMMITTEE

Acute Gastroenteritis Team

#### COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

**Acute Gastroenteritis Team 2005**

*Community Physicians*: \*Philip Lichtenstein, MD, Chair; William
DeBuys, MD

*Cincinnati Children\'s Hospital Medical Center Physicians*: \*Mitchell
Cohen, MD, Gastroenterology; \*Scott Reeves, MD, Emergency Medicine;
\*Mary Staat, MD, MPH, Infectious Diseases; \*Stavra Xanthakos, MD,
Gastroenterology; Katie Kerrey, MD, Chief Resident; Anne McCarthy, MD,
Resident

*Patient Services*: \*Lynn Daum, RN, Emergency Department; Michelle
Widecan, RN, CRNP, Emergency Department; \*Shirley Salway, RN,
Inpatient; \*Susan Smith, RD, Nutrition Services

*Division of Health Policy & Clinical Effectiveness Support*: Eloise
Clark, MPH, Facilitator; Danette Stanko, MA, MPH, Epidemiologist; \*Kate
Rich, Lead Decision Support Analyst; Carol Frese, RN, Medical Reviewer;
Edward Donovan, MD, Medical Director, Clinical Effectiveness; \*Uma
Kotagal, MBBS, MSc, VP, Division Director; Eduardo Mendez, RN, MPH, Dir.
Evidence-Based Care; Detrice Barry, RN, MSN, Education Coordinator

All Team Members and Clinical Effectiveness support staff listed above
have signed a conflict of interest declaration.

*Ad hoc Advisors*: \*Michael Farrell, MD, Chief of Staff; \*Richard
Ruddy, MD, Emergency Medicine, Director; \*Tom DeWitt, MD, Gen. &
Community Pediatrics, Director; \*Mel Rutherford, Esq, VP, Legal
Services; \*Dorine Sequist, RN, VP, Patient Services; Joel Mortensen,
PhD, PhD, HCLD, FAAM, Dir. Laboratory; Barbarie Hill, Pratt Library;
Elizabeth Elliott, MBBS, MD, FRACP, Gastro., U Sydney, Australia; Greg
Randolph, MD, Pediatrician, UNC, Chapel Hill; Joan Bothner, MD,
Emergency Med, The Children\'s Hosp, Denver

\*Member of previous Acute Gastroenteritis guideline development Teams

#### FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

The guideline was developed without external funding. All Team Members
and Clinical Effectiveness support staff listed have declared whether
they have any conflict of interest and none were identified.

#### GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: Cincinnati Children\'s
Hospital Medical Center. Evidence based clinical practice guideline for
children with acute gastroenteritis (AGE). Cincinnati (OH): Cincinnati
Children\'s Hospital Medical Center; 2001 Apr. 13 p.

The guideline was reviewed for currency in May 2006, using updated
literature searches and was determined to be current.

#### GUIDELINE AVAILABILITY

Electronic copies: Available in Portable Document Format (PDF) from the
[Cincinnati Children\'s Hospital Medical Center Web
site](http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/).

Print copies: For information regarding the full-text guideline, print
copies, or evidence-based practice support services contact the
Children\'s Hospital Medical Center Health Policy and Clinical
Effectiveness Department at <HPCEInfo@cchmc.org>.

#### AVAILABILITY OF COMPANION DOCUMENTS

The following is available:

-   Acute gastroenteritis (AGE). Guideline highlights. Cincinnati (OH):
    Cincinnati Children\'s Hospital Medical Center; 2005 Nov. 1 p.
    Electronic copies: Available in Portable Document Format (PDF) from
    the [Cincinnati Children\'s Hospital Medical Center Web
    site](http://www.cincinnatichildrens.org/NR/rdonlyres/98A59CEF-4223-431E-8928-7407EA45D444/0/GasHL.pdf).

Additional implementation tools, including computerized provider order
entry forms, history taking tool, and a model form for phone triage can
be found in the [original guideline
document](http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/gastroenteritis.htm).

#### PATIENT RESOURCES

The following Health Topics are available:

-   Gastroenteritis. Cincinnati Children\'s Hospital Medical Center,
    2006 Mar. Electronic copies: Available from the [Cincinnati
    Children\'s Hospital Medical Center Web
    site](http://www.cincinnatichildrens.org/health/info/abdomen/diagnose/gastroenteritis.htm).

-   Acute diarrhea. Cincinnati Children\'s Hospital Medical Center, 2004
    Dec. Electronic copies: Available from the [Cincinnati Children\'s
    Hospital Medical Center Web
    site](http://www.cincinnatichildrens.org/health/info/abdomen/diagnose/acute-diarrhea.htm).

Please note: This patient information is intended to provide health
professionals with information to share with their patients to help them
better understand their health and their diagnosed disorders. By
providing access to this patient information, it is not the intention of
NGC to provide specific medical advice for particular patients. Rather
we urge patients and their representatives to review this material and
then to consult with a licensed health professional for evaluation of
treatment options suitable for them as well as for diagnosis and answers
to their personal medical questions. This patient information has been
derived and prepared from a guideline for health care professionals
included on NGC by the authors or publishers of that original guideline.
The patient information is not reviewed by NGC to establish whether or
not it accurately reflects the original guideline\'s content.

#### NGC STATUS

This summary was completed by ECRI on September 1, 1998. The information
was verified by the guideline developer on December 1, 1998. This
summary was updated by ECRI on March 18, 2002, and reviewed by the
guideline developer as of May 7, 2002. This summary was updated by ECRI
on December 19, 2005. The updated information was verified by the
guideline developer on January 9, 2006. This summary was updated by ECRI
on July 14, 2006. The updated information was verified by the guideline
developer on July 21, 2006.

#### COPYRIGHT STATEMENT

This NGC summary is based on the original full-text guideline, which is
subject to the following copyright restrictions:

Copies of [Cincinnati Children\'s Hospital Medical Center
(CCHMC)](http://www.cincinnatichildrens.org/svc/alpha/h/health-policy/ev-based/default.htm)
Evidence-Based Clinical Practice Guidelines (EBCG) are available online
and may be distributed by any organization for the global purpose of
improving child health outcomes. Examples of approved uses of CCHMC\'s
EBCG include the following:

-   Copies may be provided to anyone involved in the organization\'s
    process for developing and implementing evidence-based care
    guidelines.

-   Hyperlinks to the CCHMC website may be placed on the organization\'s
    website.

-   The EBCG may be adopted or adapted for use within the organization,
    provided that CCHMC receives appropriate attribution on all written
    or electronic documents.

-   Copies may be provided to patients and the clinicians who manage
    their care.

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Date Modified: 11/3/2008