G322 IV fluids to protect against stec-hus – impact of health protection scotland guidelines on acute paediatrics services

Introduction Acute bloody diarrhoea is associated with E.Coli enterocolitis, progressing to haemolytic uraemic syndrome (STEC-HUS) in 10–15% of cases. Health Protection Scotland (HPS) guidelines recommend commencing pre-emptive IV fluids in children with acute bloody diarrhoea and high risk features until an E.Coli result is known to reduce progression and severity of STEC-HUS. The service impact of this change is unknown. Aims Establish baseline annual presentation rate of children with acute bloody diarrhoea to RHC, Glasgow Evaluate management of children eligible for pre–emptive IV fluids prior to guideline implementation Estimate service impact of guideline implementation Methods A microbiology search identified all stools sent from RHC (ED/CDU) between 1/3/18–1/3/19. Children with acute bloody diarrhoea and high risk features were identified by screening records of patients with bloody/diarrhoeal samples. Data regarding management/diagnosis was extracted. CMPI and IBD cases were excluded. Results 55 patients had acute bloody diarrhoea (9% of 577 stool samples). 8 CMPI and 7 IBD cases were excluded. Of the remaining 40, 29 had high risk features meeting criteria for pre-emptive IV fluids. 32 had blood tests and 24 had urinalysis. Of 29 high risk patients, 22 (76%) were admitted for an average of 2 days (excluding HUS) and 7 (24%) were not admitted. 14 (47%) received IV fluids >24 hours and 8 (28%) were discharged before 24 hours. 22 (76%) grew a bacterial pathogen (E.Coli (n=4), Campylobacter (n=15), Salmonella (n=3)) and 3 (10%) developed STEC-HUS. Mean time to stool culture result was 47.8 hours. Of 11 without high risk features, 1 grew a bacterial pathogen (Campylobacter). Conclusion In this cohort, implementing HPS guidelines would necessitate 22 additional inpatient hospital days for IV fluids, 8 additional blood tests and 16 additional urinalysis tests. High risk features appear sensitive for pathogenic bloody diarrhoea and captured all STEC-HUS/E.Coli cases.