Family Practise Residents' Diagnostic and Therapeutic Behaviors to Acute Diarrheal Patients

Lee, Do Won; Cho, Kang Won; Lee, Kwan Soon; Lee, Sin Jae

Abstract

BACKGROUND: The purpose of this research was to compare one hospital family practise residents' diagnostic and therapeutic behavior with a Dupont et al described Guidelines on acute infectious diarrhea in adults and HARRISON'S PRINCIPLES OF INTERNAL MEDICINE 15th edition's algorithm for the management of acute diarrheal patients.
METHODS
From March 1, 2003 to April 30, 2003, we reviewed 82 acute diarrheal patients (3.19% of the total patients) who had visited one hospital's emergency room which was located in Jeonju district. Doctor's diagnostic and therapeutic approaches were reviewed on the basis of history and physical exam. Then we compared with the standard algorithm referred above.
RESULTS
Inpatients were 36.6% (30 patients) among the total of 82 and 63.4% (52 patients) returned home after symptomatic treatment. Among the 52 return home patients, doctors did not entirely conduct stool exam. Among the 30 hospitalized patients, doctors conducted stool exam in 25% among 4 of 16 high fever patients, in 25% among 2 of 8 moderately dehydrated who had diarrhea more than 10 times per day, and in 60% among 6 of 10 patients whose symptom duration was more than 48 hours. Doctors did not use antibiotics in 76.9% (40 patients) of 52 return home patients. Quinolone and Augmentin tablets were administered to each 6 patients of 12 return home patients. Among the 30 inpatients, Augmentin injection were given to 80% (24 patients) and second-generation cephalosporin with aminoglycoside combination injection to 13.3% (4 patients) and quinolone injection to 6.7% (2 patients).
CONCLUSION
Compared with standard algorithm, doctors neglected testing stool examination that may be the most important way to diagnose the specific etiology of acute diarrhea. If we actively utilize the stool exam, it may help in providing the correct diagnosis and suitable treatment.