Enteric Pathogen Testing Importance for Children with Acute Gastroenteritis: a Modified Delphi Study

Gillian A.M. Tarr, Drew J. Persson, Phillip I. Tarr, Stephen B. Freedman

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


The application of clinical diagnostics for gastroenteritis in children has implications for a broad collection of stakeholders, impacting clinical care, communicable disease control, and laboratory utilization. To support diagnostic stewardship as gastroenteritis testing options continue to advance, it is critical to understand which enteropathogens constitute priorities for testing across stakeholder groups. Using a modified Delphi technique, we elicited opinions of subject matter experts to determine clinical and public health testing priorities. There was a high level of overall agreement (≥80%) among stakeholders (final round n  = 15) that testing was important for Campylobacter, Escherichia coli O157 and other Shiga toxin-producing E. coli, Salmonella, Shigella, Vibrio, Yersinia, norovirus, and rotavirus. Immunocompromised children were identified as a special population that warranted the additional testing of three to four bacterial and parasitic targets. To support these clinical and public health testing priorities, diagnostic stewardship strategies can be employed, such as educating clinicians, developing new decision support tools, and using multiplex testing in concert with selective result reporting and annotation. IMPORTANCE Children with diarrhea and vomiting who seek care can be infected with a wide variety of infectious agents. This study reports findings from a survey of clinical, public health, and laboratory subject matter experts on the infectious agents that are most important to test for. The majority agreed on the importance of testing children likely infected with several bacterial agents, as well as two common viruses. Although confirming a child is positive for a viral agent is unlikely to change clinical care, participants noted the importance of monitoring these viruses for public health purposes. To avoid over-testing children, however, these results should be used to support diagnostic stewardship strategies and design new decision support tools.

Original languageEnglish (US)
JournalMicrobiology Spectrum
Issue number5
StatePublished - Sep 2022

Bibliographical note

Funding Information:
S.B.F. is supported by the Alberta Children’s Hospital Foundation Professorship in Child Health and Wellness. G.A.M.T. was supported by a Canadian Institutes of Health Research (CIHR) Banting Postdoctoral Fellowship, Alberta Innovates Postgraduate Fellowship, and a University of Calgary Eyes High Postdoctoral Fellowship.

Publisher Copyright:
© 2022 Tarr et al.


  • acute gastroenteritis
  • decision support
  • diagnostic stewardship
  • enteric pathogen
  • Delphi Technique
  • Humans
  • Escherichia coli
  • Viruses
  • Gastroenteritis/diagnosis
  • Child
  • Diarrhea/diagnosis
  • Shiga Toxins

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't


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