Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
Hosp Pediatr. 2024 Feb 1;14(2):146-152. doi: 10.1542/hpeds.2023-007506.
Despite its routine use, it is unclear whether chest radiograph (CXR) is a cost-effective strategy in the workup of community-acquired pneumonia (CAP) in the pediatric emergency department (ED). We sought to assess the costs of CAP episodes with and without CXR among children discharged from the ED.
This was a retrospective cohort study within the Healthcare Cost and Utilization Project State ED and Inpatient Databases of children aged 3 months to 18 years with CAP discharged from any EDs in 8 states from 2014 to 2019. We evaluated total 28-day costs after ED discharge, including the index visit and subsequent care. Mixed-effects linear regression models adjusted for patient-level variables and illness severity were performed to evaluate the association between CXR and costs.
We evaluated 225c781 children with CAP, and 86.2% had CXR at the index ED visit. Median costs of the 28-day episodes, index ED visits, and subsequent visits were $314 (interquartile range [IQR] 208-497), $288 (IQR 195-433), and $255 (IQR 133-637), respectively. There was a $33 (95% confidence interval [CI] 22-44) savings over 28-days per patient for those who received a CXR compared with no CXR after adjusting for patient-level variables and illness severity. Costs during subsequent visits ($26 savings, 95% CI 16-36) accounted for the majority of the savings as compared with the index ED visit ($6, 95% CI 3-10).
Performance of CXR for CAP diagnosis is associated with lower costs when considering the downstream provision of care among patients who require subsequent health care after initial ED discharge.
尽管胸部 X 线（CXR）在儿科急诊部门（ED）中常规用于社区获得性肺炎（CAP）的检查，但目前尚不清楚它是否具有成本效益。我们旨在评估在 ED 出院的 CAP 患者中，进行和不进行 CXR 检查的 CAP 发作的成本。
这是一项回顾性队列研究，对象为 2014 年至 2019 年间在 8 个州的任意 ED 出院的年龄在 3 个月至 18 岁之间患有 CAP 的儿童，数据来自 Healthcare Cost and Utilization Project State ED 和 Inpatient Databases。我们评估了 ED 出院后 28 天的总费用，包括索引就诊和后续护理。采用混合效应线性回归模型，根据患者水平变量和疾病严重程度进行调整，以评估 CXR 与成本之间的关系。
我们评估了 225c781 例 CAP 患儿，86.2%的患儿在 ED 就诊时进行了 CXR。28 天发作、ED 就诊和后续就诊的中位费用分别为 314 美元（四分位距 [IQR] 208-497）、288 美元（IQR 195-433）和 255 美元（IQR 133-637）。在调整患者水平变量和疾病严重程度后，与未行 CXR 检查的患者相比，行 CXR 检查的患者在 28 天内每人可节省 33 美元（95%置信区间 [CI] 22-44）。与 ED 就诊相比，后续就诊的费用降低（26 美元，95%CI 16-36）是节省的主要部分。
在考虑初始 ED 出院后需要后续医疗保健的患者的后续医疗保健提供成本时，CAP 诊断中进行 CXR 与降低成本相关。
