Abstract
Background/objective
Previous studies showed variability in the use of diagnostic and therapeutic resources
for children with febrile acute respiratory tract infections (ARTI), including antibiotics.
Unnecessary antibiotic use has important public and individual health outcomes, but
missed antibiotic prescribing also has important consequences. We sought to determine
factors associated with antibiotic prescribing in pediatric ARTI, specifically those
with pneumonia.
Methods
We assessed national trends in the evaluation and treatment of ARTI for pediatric
emergency department (ED) patients by analyzing the National Hospital Ambulatory Medical
Care Survey from 2002 to 2013. We identified ED patients aged ≤18 with a reason for visit of ARTI, and created 4 diagnostic categories: pneumonia,
ARTI where antibiotics are typically indicated, ARTI where antibiotics are typically
not indicated, and “other” diagnoses. Our primary outcome was factors associated with
the administration or prescription of antibiotics. A multivariate logistic regression
model was fit to identify risk factors for underuse of antibiotics when they were
indicated.
Results
We analyzed 6461 visits, of which 10.2% of the population had a final diagnosis of
pneumonia and 86% received antibiotics. 41.5% of patients were diagnosed with an ARTI
requiring antibiotics, of which 53.8% received antibiotics. 26.6% were diagnosed with
ARTI not requiring antibiotics, of which 36.0% received antibiotics. Black race was
a predictor for the underuse of antibiotics in ARTIs that require antibiotics (OR:
0.72; 95% CI: 0.58–0.90).
Conclusions
For pediatric patients presenting to the ED with pneumonia and ARTI requiring antibiotics,
we found that black race was an independent predictor of antibiotic underuse.
Keywords
Abbreviations:
ARTI (acute respiratory tract infection), CAP (community acquired pneumonia), CBC (complete blood count), CDC (Centers for Disease Control), CI (confidence interval), CXR (chest radiography), ED (emergency department), ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification), MSA (metropolitan statistical area), NHAMCS (National Hospital Ambulatory Medical Care Survey), OR (odds ratio), US (United States)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: July 28, 2017
Accepted:
July 26,
2017
Received in revised form:
July 25,
2017
Received:
June 9,
2017
Footnotes
☆Funding source: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
☆☆Financial disclosure: Dr. Kanzaria has been a consultant for RAND Health and Castlight Health in the past 12 months.
★Conflict of interest: The authors have no potential conflicts of interest to disclose. The authors wish to acknowledged Sarah Sabbagh for her administrative assistance.
Identification
Copyright
Published by Elsevier Inc.
