Limitations.
enteropathogen, hematochezia, diarrhea
SECONDARY, HEMATOCHEZIA, BLOODY DIARRHEA
The study was conducted in children with diarrhea and hematochezia who presented to ED for care; thus, the results may not be generalizable to other populations and settings. Although our study has the strength of being a randomized trial, there may be response bias from the patients and physicians due to lack of blinding of the study arm allocation. However, treatments such as intravenous fluids and antibiotics administration usually depend on patient clinical status and the enteropathogen identified; thus, the impact on the study outcome due to nonblinding of allocation likely is minimal.Our lack of effect may reflect the large difference we sought to find, the fact that many physicians routinely perform blood tests on children with bloody diarrhea, that physicians may not be willing to wait for the BioFire FilmArray test result before making such a decision, and a lack of physician familiarity with the platform and how to optimally integrate results into clinical care. In addition, the transition in the standard-of-care arm from culture to a molecular platform may have impacted our results; however, the latter was limited to a four-pathogen panel and the overall difference in test turnaround time remained significant. We also lacked power to detect many of the secondary outcomes, we did not document the effect on isolation practices, and we had very few STEC-infected children, which was a key driver behind the study’s rationale. As smaller differences may be clinically meaningful and further exposure to rapid molecular platforms may alter physician practice patterns, further research exploring the benefits of rapid enteric diagnostic platforms is required.