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J Pediatr. 2014 Sep;165(3):585-91. doi: 10.1016/j.jpeds.2014.04.062. Epub 2014 Jun 25.

Variation in resource utilization for the management of uncomplicated community-acquired pneumonia across community and children's hospitals.

Author information

1
Division of Pediatric Hospital Medicine, Department of Pediatrics, Tufts University School of Medicine, Boston, MA. Electronic address: jleyenaar@post.harvard.edu.
2
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Division of General Internal Medicine, Baystate Medical Center, Springfield, MA; Department of Medicine, Tufts University School of Medicine, Boston, MA.
3
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA.
4
Center for Quality of Care Research, Baystate Medical Center, Springfield, MA; Department of Public Health, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA.

Abstract

OBJECTIVE:

To describe patterns of diagnostic testing and antibiotic management of uncomplicated pneumonia in general community hospitals and children's hospitals within hospitals and to determine the association between diagnostic testing and length of hospital stay.

STUDY DESIGN:

We conducted a retrospective cohort study of children 1-17 years of age hospitalized with the diagnosis of pneumonia from 2007 to 2010 to hospitals contributing data to Perspective Database Warehouse, assessing patterns of diagnostic testing and antibiotic management. We constructed logistic regression models of log-transformed length of stay (LOS) and grouped treatment models to ascertain whether performance of blood cultures and viral respiratory testing were associated with LOS.

RESULTS:

A total of 17 299 pneumonia cases occurred at 125 hospitals, with considerable variability in pneumonia management. Only 40 (0.2%) received ampicillin/penicillin G alone or in combination with other antibiotics, and 1318 (7.4%) received macrolide monotherapy as initial antibiotic management. Performance of blood culture and testing for respiratory viruses was associated with a statistically significant longer LOS, but these differences did not persist in grouped treatment models.

CONCLUSIONS:

We observed greater rates of diagnostic testing in this cohort of structurally diverse hospitals than previously reported at freestanding children's hospitals, with extremely low rates of narrow-spectrum antibiotic use. Tailored antibiotic stewardship initiatives at these hospitals are needed to achieve adherence to national guideline recommendations.

PMID:
24973795
PMCID:
PMC4158451
DOI:
10.1016/j.jpeds.2014.04.062
[Indexed for MEDLINE]
Free PMC Article

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