Xu Michael, Doan Quynh
From the Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Pediatr Emerg Care. 2020 May;36(5):e247-e253. doi: 10.1097/PEC.0000000000001215.
Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections-cellulitis, pneumonia, and urinary tract infections.
We conducted a single-center retrospective cohort study of all visits made to the British Columbia Children's Hospital PED from May 1, 2012, to April 30, 2013. We identified scheduled RTEDs and characterized those associated with OPAT use with regard to their measures of PED utilization and clinical features.
Of 3904 RTED visits, 1310 (33.6%) were scheduled, of which 1029 were OPAT related. Among the latter, 749 RTEDs (69%) were for cellulitis, pneumonia, or urinary tract infections. The median length of stay for OPAT-related RTEDs was 2.0 hours. For 75 (24%) of 317 index visits and 213 (28%) of 749 subsequent RTEDs, oral antibiotic therapy would have been an appropriate option and OPAT could have been avoided.
Our findings suggest that OPAT poses a sizable burden on PED utilization, with a proportion of them potentially preventable.
儿科重返急诊科（RTED）占急诊科总就诊量的3%至13%。然而，计划性RTED对儿科急诊科（PED）利用率的发生率和影响尚不清楚。住院病房的抗菌药物管理计划已被证明可改善出院时门诊胃肠外抗菌治疗（OPAT）的合理使用。此类计划在PED中的实施情况尚未见报道。本研究的目的是量化计划性RTED对OPAT的PED利用率负担，并研究OPAT的使用频率是否符合已发表的3种常见儿科感染（蜂窝织炎、肺炎和尿路感染）的实践标准。
我们对2012年5月1日至2013年4月30日期间在不列颠哥伦比亚省儿童医院PED的所有就诊病例进行了单中心回顾性队列研究。我们确定了计划性RTED，并根据其PED利用率和临床特征对与OPAT使用相关的病例进行了特征描述。
在3904次RTED就诊中，1310次（33.6%）是计划性的，其中1029次与OPAT相关。在后者中，749次RTED（69%）是因蜂窝织炎、肺炎或尿路感染。与OPAT相关的RTED的中位住院时间为2.0小时。在317次首次就诊中有75次（24%）以及在749次后续RTED中有213次（28%），口服抗生素治疗本应是合适的选择，OPAT本可避免。
我们的研究结果表明，OPAT给PED利用率带来了相当大的负担，其中一部分可能是可以预防的。
