Factors Associated With Antibiotic Prescribing and Outcomes for Pediatric Pneumonia in the Emergency Department
| Autor: | Jessi Lipscomb, Thomas N. Epperson, Lilliam Ambroggio, Samir S. Shah, Richard M. Ruddy, Sara Krueger, Judd Jacobs, Matthew J. Lipshaw, Eric J. Crotty, Mantosh S. Rattan, Todd A. Florin, Michael A. Belsky |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.drug_class Antibiotics MEDLINE Logistic regression Article 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Odds Ratio Humans Medicine Prospective Studies Practice Patterns Physicians' Child Prospective cohort study business.industry 030208 emergency & critical care medicine Pneumonia General Medicine Emergency department Odds ratio medicine.disease Confidence interval Anti-Bacterial Agents Pediatrics Perinatology and Child Health Emergency medicine Emergency Medicine Emergency Service Hospital business |
| Zdroj: | Pediatr Emerg Care |
| ISSN: | 1535-1815 0749-5161 |
| Popis: | Objectives Chest radiographs (CXRs) are often performed in children with respiratory illness to inform the decision to prescribe antibiotics. Our objective was to determine the factors associated with clinicians' plans to treat with antibiotics prior to knowledge of CXR results and the associations between preradiograph plans with antibiotic prescription and return to medical care. Methods Previously healthy children aged 3 months to 18 years with a CXR for suspected pneumonia were enrolled in a prospective cohort study in the emergency department. Our primary outcomes were antibiotic prescription or administration in the emergency department and medical care sought within 7 to 15 days after discharge. Inverse probability treatment weighting was used to limit bias due to treatment selection. Inverse probability treatment weighting was included in a logistic regression model estimating the association between the intention to give antibiotics and outcomes. Results Providers planned to prescribe antibiotics prior to CXR in 68 children (34.9%). There was no difference in the presence of radiographic pneumonia between those with and without a plan for antibiotics. Children who had a plan for antibiotics were more likely to receive antibiotics than those without (odds ratio [OR], 6.39; 95% confidence interval [CI], 3.7-11.0). This association was stronger than the association between radiographic pneumonia and antibiotic receipt (OR, 3.49; 95% CI, 1.98-6.14). Children prescribed antibiotics were more likely to seek care after discharge than children who were not (OR, 1.85; 95% CI, 1.13-3.05). Conclusions Intention to prescribe antibiotics based on clinical impression was the strongest predictor of antibiotic prescription in our study. Prescribing antibiotics may lead to subsequent medical care after controlling for radiographic pneumonia. |
| Databáze: | OpenAIRE |
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