The gaps between the guideline and clinical practice of the management of acute diarrhea in adults in Shanxi Province / 中华传染病杂志

ABSTRACT

Objective To evaluate the management of acute diarrhea in adult and to assess physician's adherence to guidelines recommended by Manatsathit working group.Methods A multicenter cross-sectional survey was carried out in 10 hospitals in Shaanxi Province with assignment of 40 patients each hospital.The difference of enumeration data between groups was analyzed using chi square test.Quantitative data were compared using t test.Results Data were collected from 400 patients.60.5％ (242/400) were female and mean age was (38.4 ± 17.5) years.In Manatsathit guideline,stool examination and stool culture for bacteria are recommended in patients with watery diarrhea with dehydration and in patients with bloody diarrhea.In this survey,of the 64 patients with dehydration,only 38 (59.4％) and 13 (23.3％) patients had done stool routine test and vibriocholera culture,respectively.Compared to Manatsathit guideline,the differences were obvious (x2 32.627 and 84.779,respectively; both P＜0.01).Of the 30 patients with bloody diarrhea,25 (83.3％) cases had stool examination done,which was roughly in line with Manatsathit guideline (x2 =3.491,P=0.062).However,stool culture for bacteria was performed only in 3 (10％) patients,which was significantly different with the guideline (x2 =49.091,P＜ 0.001).Overall,30 (7.5 ％) cases were diagnosed with acute bacillary dysentery clinically,and the remaining 370 (92.5％) were diagnosed with acute infectious diarrhea.Of the 370 patients with watery diarrhea,only 189 (51.1％) patients were prescribed with rehydration therapy,which was different with the recommendation of Manatsathit guideline (x2 =239.600,P＜0.01).Of the 216 patients who received rehydration therapy,144 (66.7％) cases should be prescribed with oral rehydration salts (ORS) and 72 cases should be prescribed with intravenous fluid replacement according to Manatsathit guideline.However,only 31 (14.4％) were prescribed ORS and up to185 (85.6％) patients received intravenous fluid replacement instead (bothx2 =122.700; both P＜0.01).On the basis of the guidelines,only 76 (19.0％) patients were eligible to use antibiotics.However,up to 258 (64.5％) patients were treated with antibiotics,which was absolutely against the recommendation of Manatsathit guideline (x2 =170.300,P＜0.01).Conclusions There are deep gaps between the clinical practice of treatment for acute diarrhea in adults in various levels of hospitals in Shaanxi Province and the recommendation of Manatsathit guideline.It is imperative to make domestic guidelines for adult acute diarrhea and to widely train physicians with algorithm for the management of adult acute diarrhea.