PREDICTORS OF PROLONGED HOSPITAL STAY AMONG CHILDREN WITH ACUTE GASTROENTERITIS

Background: Acute gastroenteritis is one of the most common causes of morbidity and hospital admission among children. Although most cases respond to appropriate rehydration and supportive treatment, some children require prolonged hospitalization, resulting in increased healthcare utilization and burden on families. Early identification of factors associated with prolonged hospital stay may facilitate timely intervention and more efficient allocation of pediatric healthcare resources. Objectives: To identify the clinical, demographic, nutritional, laboratory, and treatment-related predictors of prolonged hospital stay among children admitted with acute gastroenteritis. Patients and methods: A hospital-based analytical study was conducted at Baladruz Hospital, Diyala Governorate, Iraq, from August 2024 to June 2026. A total of 300 children diagnosed with acute gastroenteritis were included. Demographic, clinical, laboratory, and treatment-related data were collected from medical records. Prolonged hospital stay was defined as hospitalization for more than 4 days. Patients were divided into non-prolonged (≤4 days) and prolonged (>4 days) hospitalization groups. Associations were assessed using appropriate statistical tests, followed by univariate and multivariable logistic regression analyses to identify independent predictors of prolonged hospitalization. A P value <0.05 was considered statistically significant. Results: Among the 300 children, 164 (54.7%) were males and 136 (45.3%) were females, with a mean age of 3.2 ± 2.8 years. Dehydration was present in 186 (62.0%) children, including severe dehydration in 43 (14.3%). The mean hospital stay was 3.6 ± 2.4 days, and 72 (24.0%) children had prolonged hospitalization. Compared with children with non-prolonged hospitalization, those with prolonged hospitalization had significantly higher frequencies of illness lasting ≥3 days before admission, vomiting, frequent vomiting, fever, dehydration, and severe dehydration. They also had significantly higher WBC, BUN, and creatinine levels and lower serum sodium, chloride, and bicarbonate levels. In multivariable logistic regression, severe dehydration (adjusted OR=3.40, 95% CI: 1.70–6.80, P<0.001), illness duration ≥3 days before admission (adjusted OR=2.30, 95% CI: 1.30–4.10, P=0.004), frequent vomiting (adjusted OR=2.10, 95% CI: 1.20–3.80, P=0.009), hyponatremia (adjusted OR=2.60, 95% CI: 1.30–5.10, P=0.006), low serum bicarbonate (adjusted OR=2.20, 95% CI: 1.10–4.30, P=0.025), and intravenous fluid therapy (adjusted OR=1.80, 95% CI: 1.00–3.20, P=0.041) were independent predictors of prolonged hospital stay. Conclusions: Prolonged hospitalization among children with acute gastroenteritis was associated mainly with severe dehydration, delayed presentation, frequent vomiting, and electrolyte and metabolic abnormalities. Early recognition of high-risk children, prompt correction of dehydration and metabolic disturbances, and appropriate clinical monitoring may help reduce prolonged hospitalization and improve the utilization of pediatric healthcare resources.