Author/Authors :
Antonia S, Stang. Departments of Pediatrics - Emergency Medicine and Community Health Sciences - University of Calgary - Alberta Children’s Hospital Research Institute, Alberta, Canada , Trudeau, Melanie Department of Pediatrics, University of Calgary, Alberta, Canada , Vanderkooi, Otto G. Departments of Pediatrics - Microbiology Immunology and Infectious Diseases Pathology & Laboratory Medicine and Community Health Sciences - University of Calgary - Alberta Children’s Hospital Research Institute, Canada , Lee,Bonita E Department of Pediatrics - University of Alberta, Edmonton, canada , Chui, Linda Department of Laboratory Medicine and Pathology - University of Alberta, Edmonton, Canada , Pang, Xiao-Li Department of Laboratory Medicine and Pathology - University of Alberta, Edmonton, Canada , Allen, Vanessa Public Health Ontario Laboratories - University of Toronto, Ontario, Canada , Burnham, Carey-Ann D Departments of Pathology & Immunology - Molecular Microbiology and Pediatrics - Washington University in St. Louis School of Medicine, USA , Goldfarb, David M. Department of Pathology and Laboratory Medicine - BC Children’s Hospital, British Columbia, Canada , MacDonald, Judy Population Public and Indigenous Health - Cumming School of Medicine - University of Calgary, Alberta, Canada , Parsons, Brendon Department of Laboratory Medicine and Pathology - University of Alberta, Edmonton, Canada , Petrich, Astrid Department of Laboratory Medicine and Pathobiology - University of Toronto, Ontario, Canada , Pollari, Frank Enterics Surveillance and Population Studies Division - Centre for Food-Borne - Environmental and Zoonotic Infectious Diseases - Public Health Agency of Canada, Ontario, Canada , Tarr, Phillip I Division of Gastroenterology - Hepatology and Nutrition Department of Pediatrics - Washington University School of Medicine, USA , Tipples, Graham Department of Laboratory Medicine and Pathology - University of Alberta, Edmonton, Canada , Zhuo, Ran Department of Laboratory Medicine and Pathology - University of Alberta, Edmonton, Canada , Freedman, Stephen B. Sections of Pediatric Emergency Medicine and Gastroenterology - Departments of Pediatrics - University of Calgary - Alberta Children’s Hospital, Canada
Abstract :
Background
We sought to develop diagnostic test guidance definitions for pediatric enteric infections to facilitate the interpretation of positive test results in the era of multianalyte molecular diagnostic test platforms.
Methods
We employed a systematic, two-phase, modified Delphi consensus process consisting of three web-based surveys and an expert panel face-to-face meeting. In phase 1, we surveyed an advisory panel of North American experts to select pathogens requiring diagnostic test guidance definition development. In phase 2, we convened a 14-member expert panel to develop, refine, and select the final definitions through two web-based questionnaires interspersed with a face-to-face meeting. Both questionnaires asked panelists to rate the degree to which they agreed that if the definition is met the pathogen is likely to be causative of clinical illness.
Results
The advisory panel survey identified 19 pathogens requiring definitions. In the expert panel premeeting survey, 13 of the 19 definitions evaluated were rated as being highly likely (“agree” or “strongly agree”) to be responsible for acute gastroenteritis symptoms by ≥67% of respondent panel members. The definitions for the remaining six pathogens (Aeromonas, Clostridium difficile, Edwardsiella, nonenteric adenovirus, astrovirus, and Entamoeba histolytica) were indeterminate. After the expert panel meeting, only two of the modified definitions, C. difficile and E. histolytica/dispar, failed to achieve the a priori specified threshold of ≥67% agreement.
Conclusions
We developed diagnostic test guidance definitions to assist healthcare providers for 17 enteric pathogens. We identified two pathogens that require further research and definition development.
