Page 48 - 15Diarrhoeaandvomiting

Diagnosis

Table 3.1 Duration of diarrhoea in children

Study Setting Sample size Mean duration of diarrhoea
during study period
Days (SD)
Szymanski et al. (2006) 40 Hospital 41 4.0 ± 3.0
Gazala et al. (1988) 41 Hospital 53 3.7 ± 1.9
Lozano et al. (1994) 42 Hospital 28 2.3 ± 1.7
Haffejee (1990) 43 Hospital 120 2.9 ± 2.3
Khuffash et al. (1988) 44 Hospital 595 7.4 (SD not given)
Rosenfeldt et al. (2002) 45 Community 19 4.8 ± 3.5

Data on the mean duration of vomiting prior to hospital admission was given in three RCTs:
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2.4 days (range 1–6), 1.6 days (SD 1.2) and 2.5 days (SD 1.7). These RCTs were conducted
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in Australia (n = 59), Saudi Arabia (n = 150) and Finland (n = 65), respectively. Two small RCTs
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conducted in the UK provided data on vomiting during the hospital stay. In one RCT, the
numbers of children with vomiting on days 1, 2 and 3 were 7/16, 3/16 and 2/16, respectively. In
the other RCT, it was reported that, of 14 children, none experienced any vomiting over 4 days.
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Evidence summary
Evidence for this question was marked by great variation among the studies regarding the settings,
sample sizes and study period. In the five hospital-based studies, the mean duration of diarrhoea
from the time of presentation ranged from 2.3 to 7.4 days. In the small community-based study,
more than 60% of the children presenting with diarrhoea to a clinic recovered from the condition
by day 5.
In three RCTs, the mean duration of vomiting prior to hospital admission varied from 1.6 to
2.5 days. Data from two small hospital-based RCTs indicated that vomiting had ceased in most
patients within 2 or 3 days of admission.

GDG translation from evidence to recommendation

The GDG noted the lack of satisfactory data from the UK regarding the duration of diarrhoea
and vomiting in children with gastroenteritis. The available data were obtained from clinical
trials in which measurement of symptom duration was not the primary aim of the study. Many
of the studies measured duration of diarrhoea only during the period of hospital admission, and
so underestimation may have occurred. The only study based in a primary care setting was very
small. Those members of the GDG with experience of managing gastroenteritis in the community
believed that diarrhoea usually resolves within 5–7 days but occasionally may persist till 14 days.
That view is consistent with the data presented in Table 3.1.

Recommendation on duration of diarrhoea and vomiting
Be aware that in children with gastroenteritis:
• diarrhoea usually lasts for 5–7 days, and in most it stops within 2 weeks
• vomiting usually lasts for 1–2 days, and in most it stops within 3 days.

Clinical question
What factors influence the natural history of gastroenteritis?
Five relevant studies were identified to address this question. Four cross-sectional studies with
EL = 3 reported on the clinical features associated with various infective pathogens 51–44 and three
of them were conducted in Europe. The fourth study is a case–control study [EL = 2+] from India
reporting on the risk factors for persistent diarrhoea. 54

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