| Popis: |
Background: Children with cervical lymphadenitis often undergo imaging studies (e.g., computed tomography (CT), ultrasound) to evaluate for an abscess that may require surgical drainage. There is no established evidence base to guide optimal imaging strategies for this population.Objectives: To describe variation in imaging practices and examine the association between early imaging and outcomes in children hospitalized with cervical lymphadenitis.Methods: We conducted a multicenter cross-sectional study using the Pediatric Health Information Systems (PHIS) database, which provides administrative data from 50 children’s hospitals. We included children 2 months – 18 years old hospitalized with a diagnosis of cervical lymphadenitis between July 2013-December 2017. We excluded children with complex chronic conditions, children transferred from another institution, and those who had a prior hospitalization for lymphadenitis. To examine variation across hospitals, we calculated the proportion of patients at each hospital who received any imaging study, early imaging (conducted on day 0 of hospitalization), multiple imaging studies, and CT imaging. To examine the association between early imaging and outcomes (i.e., multiple imaging studies, surgical drainage, 30-day readmission, length of stay) we used generalized linear or logistic mixed effects modeling which included patient demographic characteristics and clinical markers of illness duration and severity with random effect for hospital to account for clustering. Results: Among 10,014 children with cervical lymphadenitis, 61% received early imaging. There was substantial hospital-level variation in imaging practices. Compared with children who did not receive early imaging, children who received early imaging had increased odds of having multiple imaging studies [adjusted odds ratio (aOR) 3.0, 95% confidence interval(CI) 2.6-3.6], surgical drainage (aOR 1.3, 95% CI 1.1-1.4), and 30-day readmission for lymphadenitis (aOR 1.5, 95% CI 1.2-1.9) as well as longer lengths of stay (adjusted rate ratio 1.2, 95% CI 1.1-1.2).Conclusions: Imaging practices in cervical lymphadenitis were variable across children’s hospitals. Children receiving early imaging had more resource utilization and intervention when compared with children who did not receive early imaging. Our findings may represent a cascade effect, in which routinely conducted early imaging prompts clinicians to pursue more testing and interventions in this population. |
