Children's Hospital, Division of Emergency Medicine, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2012 Nov;130(5):e823-30. doi: 10.1542/peds.2012-1285. Epub 2012 Oct 22.
Clinical practice guidelines (CPGs) assist clinicians in making appropriate diagnostic and treatment decisions based on available evidence. The objective of this study was to describe the availability and content of institutional community-acquired pneumonia (CAP) CPGs, and to evaluate the association between institutional CPGs and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP.
This multicenter retrospective cohort study included children aged 1 to 18 years hospitalized with CAP from July 1, 2009, to June 30, 2011. CPGs from each institution were reviewed to abstract information regarding diagnostic testing and antimicrobial selection. We compared overall and specific utilization patterns, antimicrobial use, and hospital length of stay (LOS) for children with CAP between hospitals with and without CPGs.
Thirteen (31.7%) of 41 hospitals had an institutional CPG for nonsevere CAP. There was marked heterogeneity among CPGs. Among the 19,710 children hospitalized with CAP, cost of care, hospital LOS, and 14-day readmission rate were not associated with the presence of a CPG. CPGs did not influence ordering patterns for most diagnostic tests, including blood culture and chest radiographs. Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a CPG recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a CPG (odds ratio = 2.7; 95% confidence interval = 1.4-5.5).
The availability of a CAP CPG had minimal impact on resource utilization and was not associated with cost or hospital LOS. Institutional CPGs, however, did influence patterns of antimicrobial use.
临床实践指南（CPGs）可帮助临床医生根据现有证据做出适当的诊断和治疗决策。本研究旨在描述机构获得性肺炎（CAP）CPG 的可用性和内容，并评估机构 CPG 与儿童住院 CAP 患者的护理利用、抗生素使用和结局之间的关联。
本多中心回顾性队列研究纳入了 2009 年 7 月 1 日至 2011 年 6 月 30 日期间因 CAP 住院的 1 至 18 岁儿童。对每个机构的 CPG 进行了回顾，以提取有关诊断性检查和抗菌药物选择的信息。我们比较了有无 CPG 的医院之间 CAP 患儿的总体和特定利用模式、抗生素使用和住院时长（LOS）。
41 家医院中有 13 家（31.7%）有非重症 CAP 的机构性 CPG。CPG 之间存在显著异质性。在 19710 例因 CAP 住院的儿童中，护理费用、住院 LOS 和 14 天再入院率与 CPG 的存在无关。CPG 并未影响大多数诊断性检查的检查模式，包括血培养和胸部 X 线片。在建议将青霉素或氨芐青霉素作为一线药物的机构中，46.3%的患儿接受了这些抗生素治疗，而在没有 CPG 的机构中，这一比例为 23.9%（比值比=2.7；95%置信区间=1.4-5.5）。
CAP CPG 的可用性对资源利用的影响极小，与成本或住院 LOS 无关。然而，机构 CPG 确实影响了抗生素使用模式。
