Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, Calif (PP Chaudhari); and Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass (MC Monuteaux and RG Bachur).
Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, Calif (PP Chaudhari); and Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass (MC Monuteaux and RG Bachur).
Acad Pediatr. 2019 Mar;19(2):203-208. doi: 10.1016/j.acap.2018.05.011. Epub 2018 Jun 1.
Oral antibiotics effectively treat most pediatric urinary tract infections (UTIs); however, children with UTIs are frequently admitted. We examined variation and trends in admission for children with UTIs plus investigated the relationship between admission and emergency department (ED) revisits for those initially managed on an outpatient basis. We hypothesized that hospitals would have similar 3-day revisit rates regardless of the admission rate at the index visit.
This was a retrospective analysis of 36 hospitals in the Pediatric Health Information System. ED visits for children aged <2 years presenting with UTI between 2010 and 2016 were studied. Main outcomes were age-stratified and included admission and 3-day ED revisit rates. Regression analyses were used to test hospital-level associations between outcomes and linear temporal trends.
A total of 41,792 visits were studied. The overall admission rate was 27%. The admission rate was 89% for children aged <2 months and 15% for those aged 2 to 24 months. Interhospital admission rates varied from 6% to 64%. Admission and revisit rates were inversely related (mean change, -0.07; 95% confidence interval [CI], -0.13 to -0.02 per 1% increase in admission rate); however, lower admission rates were not associated with increased revisits leading to admission (mean change, -0.02; 95% CI, -0.07 to 0.03). Over the study period, admission rates were stable (test for linear trend: adjusted odds ratio [aOR], 0.99; 95% CI, 0.95-1.02); however, among infants aged <2 months, admissions decreased (aOR, 0.92; 95% CI, 0.88-0.97).
A substantial variation in admission rates exists for children with UTI. Although hospitals with lower admission rates had higher revisit rates, those hospitals did not have an increase in revisits with subsequent admission, supporting the goal of outpatient management.
口服抗生素可有效治疗大多数儿科尿路感染（UTI）；然而，患有 UTI 的儿童经常住院。我们研究了患有 UTI 的儿童住院的变化和趋势，并调查了那些最初在门诊接受治疗的患者的住院与急诊（ED）复诊之间的关系。我们假设，无论索引就诊时的入院率如何，医院的 3 天复诊率都相似。
这是对 2010 年至 2016 年间在儿科健康信息系统中的 36 家医院进行的回顾性分析。研究了年龄<2 岁的因 UTI 就诊于 ED 的患儿。主要结局是按年龄分层的包括入院率和 3 天 ED 复诊率。回归分析用于检验医院层面结局与线性时间趋势之间的相关性。
共研究了 41792 次就诊。总体入院率为 27%。<2 个月龄患儿的入院率为 89%，2-24 个月龄患儿的入院率为 15%。医院间入院率差异为 6%-64%。入院率和复诊率呈负相关（平均变化，-0.07；95%置信区间[CI]，-0.13 至 -0.02，每增加 1%的入院率）；然而，较低的入院率与增加复诊导致入院无关（平均变化，-0.02；95%CI，-0.07 至 0.03）。在研究期间，入院率保持稳定（线性趋势检验：调整优势比[aOR]，0.99；95%CI，0.95-1.02）；然而，在<2 个月龄的婴儿中，入院人数减少（aOR，0.92；95%CI，0.88-0.97）。
患有 UTI 的儿童的入院率存在很大差异。尽管入院率较低的医院复诊率较高，但这些医院并没有因随后的入院而增加复诊，这支持了门诊管理的目标。
