Severe Outcomes in Pediatric Gastrointestinal Infections Presenting to Emergency Departments: A National Surveillance Study
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Introduction
Pediatric gastrointestinal (GI) infections are a major cause of emergency department (ED) visits, yet the epidemiology of severe cases requiring hospitalization or intensive care remains poorly characterized. This study assessed the incidence, predictors, and temporal patterns of severe pediatric GI infections using national surveillance data.
Methods
We analyzed 7,326,429 records from the National Electronic Injury Surveillance System (NEISS) for patients ≤ 18 years with narrative descriptions (n=2,876,152). GI infections were identified using keywords including vomiting, diarrhea, nausea, food poisoning, and pathogens such as Salmonella, E. coli, norovirus, Giardia, Campylobacter, and Shigella. Severe cases were defined by hospitalization, ICU admission, intravenous fluid administration, or hospital transfer. Weighted incidence rates were calculated per 100,000 ED visits. Multivariable logistic regression adjusting for year, age, sex, and month evaluated associations with severe outcomes. Seasonal and yearly trends were also examined.
Results
Among pediatric ED visits, 438,354 weighted cases (0.50%) involved GI infections. Severe outcomes occurred in 0.82% of GI infection cases versus 0.21% in non-GI visits, equating to 8,179 versus 2,068 severe cases per 100,000 ED visits. GI infection was strongly associated with severe outcomes (adjusted OR=3.95, 95% CI: 3.82–4.09, p<0.001). Younger age (OR=0.99 per year, p<0.001) and male sex were also significant predictors. Seasonal peaks were observed in March, with troughs in May and December.
Conclusions
Pediatric GI infections carry nearly four-fold increased odds of severe outcomes, highlighting a substantial burden. Seasonal variability underscores the need for preventive measures, food safety initiatives, and targeted public health interventions to reduce severe pediatric GI infections.
