Management of Pediatric Pneumonia: A Decade After the PIDS/IDSA Guideline
AUTHORS
- PMID: 37352841 [PubMed].
ABSTRACT
BACKGROUND: Incomplete uptake of guidelines can lead to non-standardized care, increased expenditures, and adverse clinical outcomes. The objective of this study was to evaluate the impact of the 2011 PIDS/IDSA pediatric community acquired pneumonia (CAP) guideline that emphasized aminopenicillin use and deemphasized the use of chest radiographs (CXR) in certain populations.
METHODS: This quasi-experimental study queried a national administrative database of children’s hospitals to identify children 3 months-18 years with CAP who visited one of 28 participating hospitals from 2009-2021. 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 COVID-19 pandemic.
RESULTS: Of 315,384 children with CAP, 71,804 (22.8%) were hospitalized. Among hospitalized children, there was a decrease in blood cultures 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), while the rate of obtaining chest radiographs (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.
CONCLUSION: 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.
Tags: 2023 Alumni Publications