Diarrheal diseases are the among the leading cause of death in children worldwide, most of which occur in low-income countries. In high-income countries, pediatric diarrhea remains a major utilization of healthcare resources. Treatment of diarrhea is mostly empiric, with antibiotic use mostly based on clinical suspicion for bacterial causes. However, the majority of cases of diarrhea do not benefit from antibiotic use, and inappropriate use leads to toxicity and resistance. Furthermore, despite the increasing availability of rapid molecular testing, there is little data to base a decision of whom or when to test. Our overarching goal is to develop and validate clinical decision tools for management of diarrheal illnesses in children of both high and low resource settings. We will utilize prospectively-collected data from two recently-completed multicenter cohort studies of pediatric diarrhea. These studies feature extensive etiologic testing, well-characterized clinical elements, and longitudinal outcome data. We have assembled a team with expertise in pediatric diarrhea, clinical prediction rules, and machine learning methods.
In Aim 1, we will use domestic data to develop and validate: a) a score for bacterial etiology, and b) a score for which patients are likely to benefit from further testing. We will derive the scores using data from IMPACT, an NIH-sponsored study of 1200 children from 5 US Emergency Departments, and validate using electronic health records from the Utah Intermountain Health System.
In Aim 2, we will use international data to develop and validate: a) a diagnostic score for bacterial etiology, and b) a prognostic score for risk stratification of children who go on to poor outcomes. We will derive the scores using data from GEMS, a study of over 9400 children across 7 low-resource countries, and validate using VIDA study of children in 3 African countries. Completion of the Aims will result in the availability of a number of clinical tools that healthcare workers worldwide can use for evidence-based care of children with diarrhea.

Public Health Relevance

Diarrheal diseases are a leading cause of morbidity and mortality in children worldwide. The management of childhood diarrhea often depend on what type of pathogen is responsible, but in many cases testing is not affordable or feasible. We propose studies to develop clinical scores to make it easier for healthcare workers to decide how to manage children with diarrhea.

Agency
National Institute of Health (NIH)
Institute
National Institute of Allergy and Infectious Diseases (NIAID)
Type
Research Project (R01)
Project #
1R01AI135114-01A1
Application #
9596046
Study Section
Clinical Research and Field Studies of Infectious Diseases Study Section (CRFS)
Program Officer
Baqar, Shahida
Project Start
2018-05-08
Project End
2022-04-30
Budget Start
2018-05-08
Budget End
2019-04-30
Support Year
1
Fiscal Year
2018
Total Cost
Indirect Cost
Name
University of Utah
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
009095365
City
Salt Lake City
State
UT
Country
United States
Zip Code
84112
Schlaberg, Robert; Barrett, Amanda; Edes, Kornelia et al. (2018) Fecal Host Transcriptomics for Non-Invasive Human Mucosal Immune Profiling: Proof of Concept in Clostridium Difficile Infection. Pathog Immun 3:164-180