Sections of Emergency Medicine and Hospital Medicine, Children's Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA.
Children's Hospital Association, Lenexa, Kansas, USA.
Clin Infect Dis. 2023 Nov 30;77(11):1604-1611. doi: 10.1093/cid/ciad385.
Incomplete uptake of guidelines can lead to nonstandardized care, increased expenditures, and adverse clinical outcomes. The objective of this study was to evaluate the impact of the 2011 Pediatric Infectious Diseases Society and Infectious Diseases Society of America (PIDS/IDSA) pediatric community-acquired pneumonia (CAP) guideline that emphasized aminopenicillin use and de-emphasized the use of chest radiographs (CXRs) in certain populations.
This quasi-experimental study queried a national administrative database of children's hospitals to identify children aged 3 months-18 years with CAP who visited 1 of 28 participating hospitals from 2009 to 2021. PIDS/IDSA pediatric CAP guideline recommendations regarding antibiotic therapy, diagnostic testing, and imaging were evaluated. Segmented regression interrupted time series was used to measure guideline-concordant practices with interruptions for guideline publication and the Coronavirus Disease 2019 (COVID-19) pandemic.
Of 315 384 children with CAP, 71 804 (22.8%) were hospitalized. Among hospitalized children, there was a decrease in blood culture performance (0.5% per quarter) and increase in aminopenicillin prescribing (1.1% per quarter). Among children discharged from the emergency department (ED), there was an increase in aminopenicillin prescription (0.45% per quarter), whereas the rate of obtaining CXRs declined (0.12% per quarter). However, use of CXRs rebounded during the COVID-19 pandemic (increase of 1.56% per quarter). Hospital length of stay, ED revisit rates, and hospital readmission rates remained stable.
Guideline publication was associated with an increase of aminopenicillin prescribing. However, rates of diagnostic testing did not materially change, suggesting the need to consider implementation strategies to meaningfully change clinical practice for children with CAP.
不完全遵循指南可能导致护理不规范、支出增加和临床结果不佳。本研究旨在评估 2011 年儿科学会传染病分会（PIDS/IDSA）儿童社区获得性肺炎（CAP）指南的影响，该指南强调使用氨基青霉素，在某些人群中减少使用胸部 X 光检查（CXR）。
这项准实验研究查询了一家儿童医院的国家管理数据库，以确定 2009 年至 2021 年期间在 28 家参与医院就诊的年龄在 3 个月至 18 岁的 CAP 患儿。评估了 PIDS/IDSA 儿科 CAP 指南关于抗生素治疗、诊断检测和影像学的建议。采用分段回归中断时间序列来衡量指南一致的实践，并中断了指南发布和 2019 年冠状病毒病（COVID-19）大流行。
在 315384 例 CAP 患儿中，71804 例（22.8%）住院。在住院患儿中，血培养检查的比例下降（每季度下降 0.5%），而使用氨基青霉素的比例增加（每季度增加 1.1%）。在从急诊科出院的患儿中，氨基青霉素处方的比例增加（每季度增加 0.45%），而 CXR 检查的比例下降（每季度下降 0.12%）。然而，在 COVID-19 大流行期间，CXR 的使用量反弹（每季度增加 1.56%）。住院时间、急诊科复诊率和医院再入院率保持稳定。
指南发布与氨基青霉素处方的增加有关。然而，诊断检测的比率并没有实质性变化，这表明需要考虑实施策略，以切实改变儿童 CAP 的临床实践。
