Department of Emergency Medicine & Pediatrics, University of California, San Francisco, 550 16th Street, San Francisco, CA 94143, United States; Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States.
Department of Emergency Medicine, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA 94110, United States.
Am J Emerg Med. 2018 Feb;36(2):218-225. doi: 10.1016/j.ajem.2017.07.081. Epub 2017 Jul 28.
BACKGROUND/OBJECTIVE: Previous studies showed variability in the use of diagnostic and therapeutic resources for children with febrile acute respiratory tract infections (ARTI), including antibiotics. Unnecessary antibiotic use has important public and individual health outcomes, but missed antibiotic prescribing also has important consequences. We sought to determine factors associated with antibiotic prescribing in pediatric ARTI, specifically those with pneumonia.
We assessed national trends in the evaluation and treatment of ARTI for pediatric emergency department (ED) patients by analyzing the National Hospital Ambulatory Medical Care Survey from 2002 to 2013. We identified ED patients aged ≤18 with a reason for visit of ARTI, and created 4 diagnostic categories: pneumonia, ARTI where antibiotics are typically indicated, ARTI where antibiotics are typically not indicated, and "other" diagnoses. Our primary outcome was factors associated with the administration or prescription of antibiotics. A multivariate logistic regression model was fit to identify risk factors for underuse of antibiotics when they were indicated.
We analyzed 6461 visits, of which 10.2% of the population had a final diagnosis of pneumonia and 86% received antibiotics. 41.5% of patients were diagnosed with an ARTI requiring antibiotics, of which 53.8% received antibiotics. 26.6% were diagnosed with ARTI not requiring antibiotics, of which 36.0% received antibiotics. Black race was a predictor for the underuse of antibiotics in ARTIs that require antibiotics (OR: 0.72; 95% CI: 0.58-0.90).
For pediatric patients presenting to the ED with pneumonia and ARTI requiring antibiotics, we found that black race was an independent predictor of antibiotic underuse.
背景/目的：先前的研究表明，儿童急性呼吸道感染（ARTI），包括抗生素在内的诊断和治疗资源的使用存在差异。不必要的抗生素使用对公共卫生和个人健康都有重要影响，但错过抗生素的处方也有重要的后果。我们试图确定与儿科 ARTI 抗生素使用相关的因素，特别是那些患有肺炎的儿童。
我们通过分析 2002 年至 2013 年的国家医院门诊医疗调查，评估了儿科急诊部门（ED）患者 ARTI 的评估和治疗的国家趋势。我们确定了 ED 患者年龄≤18 岁，因 ARTI 就诊，并创建了 4 个诊断类别：肺炎、通常需要抗生素的 ARTI、通常不需要抗生素的 ARTI 和“其他”诊断。我们的主要结果是与抗生素的使用或处方相关的因素。我们拟合了一个多变量逻辑回归模型，以确定在需要使用抗生素时抗生素使用不足的危险因素。
我们分析了 6461 次就诊，其中 10.2%的患者最终诊断为肺炎，86%的患者接受了抗生素治疗。41.5%的患者被诊断为需要抗生素的 ARTI，其中 53.8%的患者接受了抗生素治疗。26.6%的患者被诊断为不需要抗生素的 ARTI，其中 36.0%的患者接受了抗生素治疗。黑种人是需要使用抗生素的 ARTI 抗生素使用不足的预测因素（OR：0.72；95%CI：0.58-0.90）。
对于因肺炎和需要抗生素的 ARTI 而就诊于 ED 的儿科患者，我们发现黑种人是抗生素使用不足的独立预测因素。
