The influence of chest X-ray results on antibiotic prescription for childhood pneumonia in the emergency department.

Autor: van de Maat JS; Department of General Paediatrics, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands., Garcia Perez D; Department of General Paediatrics, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands., Driessen GJA; Department of Paediatrics, HAGA-Juliana Children's Hospital, Den Haag, The Netherlands., van Wermeskerken AM; Department of Paediatrics, Flevoziekenhuis, Almere, The Netherlands., Smit FJ; Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam, The Netherlands., Noordzij JG; Department of Paediatrics, Reinier de Graaf Gasthuis, Delft, The Netherlands., Tramper-Stranders G; Department of Paediatrics, Franciscus Gasthuis &Vlietland, locatie Gasthuis, Rotterdam, The Netherlands., Obihara CC; Department of Paediatrics, Elisabeth Tweestedenziekenhuis, Tilburg, The Netherlands., Punt J; Department of Paediatrics, Langeland Ziekenhuis, Zoetermeer, The Netherlands., Moll HA; Department of General Paediatrics, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands., Oostenbrink R; Department of General Paediatrics, Erasmus MC - Sophia Children's Hospital, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands. r.oostenbrink@erasmusmc.nl.
Jazyk: angličtina
Zdroj: European journal of pediatrics [Eur J Pediatr] 2021 Sep; Vol. 180 (9), pp. 2765-2772. Date of Electronic Publication: 2021 Mar 22.
DOI: 10.1007/s00431-021-03996-2
Abstrakt: The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016-2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9-30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48-21.2]). Abnormalities on CXR were not significantly associated with antibiotic prescription.Conclusion: Performance of CXR was independently associated with more antibiotic prescription, regardless of its results. The limited influence of CXR results on antibiotic prescription highlights the inferior role of CXR on treatment decisions for suspected lower RTI in the ED. What is Known: • Chest X-ray (CXR) has a high inter-observer variability and cannot distinguish between bacterial or viral pneumonia. • Current guidelines recommend against routine use of CXR in children with uncomplicated respiratory tract infections (RTIs) in the outpatient setting. What is New: • CXR is still frequently performed in non-complex children suspected of lower RTIs in the emergency department • CXR performance was independently associated with more antibiotic prescriptions, regardless of its results, highlighting the inferior role of chest X-rays in treatment decisions.
(© 2021. The Author(s).)
Databáze: MEDLINE
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