Ecochard-Dugelay Emmanuelle, Beliah Muriel, Boisson Caroline, Perreaux Francis, de Laveaucoupet Jocelyne, Labrune Philippe, Epaud Ralph, Ducou-Lepointe Hubert, Bouyer Jean, Gajdos Vincent
Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Le Kremlin Bicêtre, France.
APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France.
PLoS One. 2014 May 2;9(5):e96189. doi: 10.1371/journal.pone.0096189. eCollection 2014.
Management of acute respiratory tract infection varies substantially despite this being a condition frequently encountered in pediatric emergency departments. Previous studies have suggested that the use of antibiotics was higher when chest radiography was performed. However none of these analyses had considered the inherent indication bias of observational studies.
The aim of this work was to assess the relationship between performing chest radiography and prescribing antibiotics using a propensity score analysis to address the indication bias due to non-random radiography assignment.
We conducted a prospective study of 697 children younger than 2 years of age who presented during the winter months of 2006-2007 for suspicion of respiratory tract infection at the Pediatric Emergency Department of an urban general hospital in France (Paris suburb). We first determined the individual propensity score (probability of having a chest radiography according to baseline characteristics). Then we assessed the relation between radiography and antibiotic prescription using two methods: adjustment and matching on the propensity score.
We found that performing a chest radiography lead to more frequent antibiotic prescription that may be expressed as OR = 2.3, CI [1.3-4.1], or as an increased use of antibiotics of 18.6% [0.08-0.29] in the group undergoing chest radiography.
Chest radiography has a significant impact on the management of infants admitted for suspicion of respiratory tract infection in a pediatric emergency department and may lead to unnecessary administration of antibiotics.
尽管急性呼吸道感染是儿科急诊科常见病症，但对其的治疗方法却存在很大差异。此前的研究表明，进行胸部X光检查时抗生素的使用频率更高。然而，这些分析均未考虑观察性研究中固有的指征偏倚。
本研究旨在通过倾向评分分析评估胸部X光检查与抗生素处方之间的关系，以解决因非随机X光检查分配导致的指征偏倚问题。
我们对2006年至2007年冬季期间在法国（巴黎郊区）一家城市综合医院的儿科急诊科因疑似呼吸道感染就诊的697名2岁以下儿童进行了一项前瞻性研究。我们首先确定个体倾向评分（根据基线特征进行胸部X光检查的概率）。然后，我们使用两种方法评估X光检查与抗生素处方之间的关系：倾向评分调整和匹配。
我们发现，进行胸部X光检查会导致更频繁地使用抗生素，这可以表示为OR = 2.3，CI [1.3 - 4.1]，或者在接受胸部X光检查的组中抗生素使用增加18.6% [0.08 - 0.29]。
胸部X光检查对儿科急诊科因疑似呼吸道感染入院的婴儿的治疗有重大影响，可能导致不必要的抗生素使用。
