A systematic review of tools for predicting complications in patients with acute infectious diarrhea

Acute infectious diarrhea, defined as lasting <14 days and being of infectious etiology, is usually self-limiting and rarely fatal [1]. A frequent cause of outpatient and emergency department (ED) visits, it is having a significant impact on healthcare resource use around the world. The Centers for Disease Control and Prevention estimate there are >178 million cases of acute infectious diarrhea in the United States annually. Based on self-reported data, the estimate rates of acute diarrhea per person per year has almost doubled in the first decade of the 21st century [2]. The annual cost of this disease is estimated to be approximately $77 billion to the United States economy [3]. Acute diarrheal illness is a major public health issue against which control efforts are needed [1].

Except in specific cases (bloody stools, prolonged or severe symptoms, patient immunocompromised or with significant comorbidities), diagnostic tests to identify a specific pathogen are rarely indicated given the benign and self-resolutive course of most presentations. Moreover, oral rehydration is usually sufficient to prevent dehydration [4]. Most patients at low risk of complications do not need to see a physician and could refrain from unnecessary use of healthcare resources. However, estimating the risk of a patient is a complex task.

Risk stratification tools may help predict the need for investigation or treatment and thereby optimize the use of healthcare resources. A large number of these tools have been shown to improve cost-effectiveness while minimizing unnecessary diagnostic imaging, treatment complications, and unnecessary admissions [[5], [6], [7], [8], [9]]. Most of these tools have been developed as decision aids for physicians, and few are intended to help patients and caregivers identify the most appropriate care pathway for the condition [10,11]. The aim of this systematic review was to identify risk stratification tools for use by clinicians or patients to predict the risk of complications arising from acute infectious diarrhea in patients presenting at an outpatient clinic or ED.

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