Coon Eric R, Maloney Christopher G, Shen Mark W
Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah; and
Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah; and.
Hosp Pediatr. 2015 Mar;5(3):111-8. doi: 10.1542/hpeds.2014-0110.
Imperfect diagnostic tools make it difficult to know the extent to which a bacterial process is contributing to respiratory illness, complicating the decision to prescribe antibiotics. We sought to quantify diagnostic and antibiotic prescribing disagreements between emergency department (ED) and pediatric hospitalist physicians for children admitted with respiratory illness.
Manual chart review was used to identify testing, diagnostic, and antibiotic prescribing decisions for consecutive children admitted for respiratory illness in a winter (starting February 20, 2012) and a summer (starting August 20, 2012) season to a tertiary, freestanding children's hospital. Respiratory illness diagnoses were grouped into 3 categories: bacterial, viral, and asthma.
A total of 181 children admitted for respiratory illness were studied. Diagnostic discordance was significant for all 3 types of respiratory illness but greatest for bacterial (P<.001). Antibiotic prescribing discordance was significant (P<.001), with pediatric hospitalists changing therapy for 93% of patients prescribed antibiotics in the ED, including stopping antibiotics altogether for 62% of patients.
Significant diagnostic and antibiotic discordance between ED and pediatric hospitalist physicians exists for children admitted to the hospital for respiratory illness.
不完善的诊断工具使得难以知晓细菌感染在呼吸道疾病中所占的比例，这使得抗生素处方决策变得复杂。我们试图量化急诊科（ED）医生与儿科住院医生对于因呼吸道疾病入院儿童的诊断及抗生素处方差异。
采用人工病历审查，以确定一所独立的三级儿童医院在冬季（从2012年2月20日开始）和夏季（从2012年8月20日开始）连续收治的因呼吸道疾病入院儿童的检测、诊断及抗生素处方决策。呼吸道疾病诊断分为3类：细菌性、病毒性和哮喘。
共研究了181例因呼吸道疾病入院的儿童。所有3种类型的呼吸道疾病诊断不一致均很显著，但细菌性疾病最为严重（P<0.001）。抗生素处方差异显著（P<0.001），儿科住院医生对急诊科93%使用抗生素治疗的患者更改了治疗方案，其中62%的患者完全停用了抗生素。
对于因呼吸道疾病入院的儿童，急诊科医生与儿科住院医生之间存在显著的诊断及抗生素处方差异。
