It Is Time for a Gastroenteritis Guideline.

In this month’s issue of Hospital Pediatrics , there are 2 articles that directly address overdiagnosis and low-value care in infants and children with acute gastroenteritis. Nabower et al1 contributed an assessment in variation of care and resource use in 38 hospitals in the United States. Some of the findings in this article are encouraging. For instance, over time, these hospitals have witnessed a mild decrease in some unnecessary resource use such as computed tomography scans. However, many of these advances were tempered by remarkable increases in other forms of costly, and often unnecessary, care. Indeed, whereas computed tomography scans were reduced from 7.8% of cases to 6.3% of cases (a small but significant reduction), unnecessary imaging skyrocketed from 18.6% to 27.4% because of an increase in ultrasound use. Likewise, whereas some laboratory testing was reduced, overall laboratory testing was far higher than recommendations the Centers for Disease Control and Prevention (CDC) guideline would suggest are appropriate.2 The authors conclude, appropriately, that there remains significant unnecessary resource use in children with gastroenteritis, which might be effectively addressed by having future guidelines on acute gastroenteritis and quality initiatives. One key hidden problem with this article is …