ABSTRACT
OBJECTIVE: Despite lack of benefit, antibiotics are overused in management of asthma exacerbation in children. In this study, data from a single children's hospital were analyzed to identify factors and outcomes associated with antibiotic use in children hospitalized with asthma. METHODS: The study population was identified by using administrative data from 2012 to 2015, with subsequent verification of asthma. We analyzed factors associated with antibiotic use (demographic, seasonal, clinical) and outcome (length of stay [LOS]) with respect to: 1) disposition to pediatric floor (PF) or pediatric intensive care unit (PICU); and 2) evidence of coexisting bacterial infection and/or fever. Statistical analysis included univariate and controlled regression models. Data are presented as median and IQR for continuous variables and OR and regression coefficient (ß) with 95% CIs for regression analyses. RESULTS: Of 600 patients, 28.8% were admitted to PICU, 14.8% had verified bacterial infection, and 53.8% received antibiotic, mainly azithromycin. Nearly all PICU patients were treated with antibiotic, irrespective of coexisting bacterial infection or fever. Among PF patients, nearly 30% without bacterial infection or fever and 40% with fever alone received antimicrobials. Overall risk for antibiotic treatment was associated with older age, female sex, desaturation events, oxygen supplementation, and PICU admission. Additionally, antibiotic treatment was associated with 13- to 19-hour increased LOS for PF patients without bacterial infection and/or fever. CONCLUSIONS: Almost half of pediatric patients admitted with asthma exacerbation received antibiotic therapy with no clear indication, which was associated with prolonged LOS.
ABSTRACT
BACKGROUND: Utilization of procalcitonin (PCT) is challenging for hospital pediatricians because of uncertainty in clinical interpretation. We used a PCT decision cut-off value (<0.15 ng/mL) to identify if PCT can differentiate bacterial infections from viral and other conditions in pediatric patients who presented for hospital-based care. METHODS: This retrospective study included PCT tested patients who presented to our children's hospital from 2017 to 2020. We analyzed relevant demographic, laboratory, treatment, and clinical data, including discharge diagnoses consolidated into bacterial infections, viral syndromes, and other conditions by the highest PCT defined as ≤0.15 ng/mL (Group A) or >0.15 ng/mL (Group B). We used regression models to identify factors associated with PCT above decision limits and the role of PCT levels in the duration of antibiotic therapy. RESULTS: Of 238 patients, 32.8% constituted Group A. Bacterial infections represent 25.6% of diagnoses for patients in Group A and 55% for Group B (P<0.001), however, the distribution of bacterial infection types, including bacteremia, was comparable. Number of PCT tests performed and C-reactive protein (CRP) ≥5 mg/L, but no other factors were significantly associated with PCT >0.15 ng/mL. PCT levels did not predict the length of antibiotic therapy, which depended on duration of hospitalization and increased CRP. CONCLUSIONS: PCT as a single measurement above or below a decision cut-off value of 0.15 ng/mL does not specify bacterial infections or predict the duration of antibiotic therapy in hospitalized pediatric patients.
ABSTRACT
Asthma is a leading cause of health disparity in children. This study explores the joint effect of race/ethnicity and insurance type on risk for reuse of urgent services within a year of hospitalization. Data were collected from 604 children hospitalized with asthma between 2012 and 2015 and stratified with respect to combination of patients' insurance status (public vs. private) and race/ethnicity (white vs. nonwhite). Highest rates for at least one emergency department (ED) revisit (49.5%, 95% CI 42.5, 56.5) and for average revisits (1.03, 95% CI 0.83, 1.22) were recorded in nonwhite children with public insurance. Adjusted models revealed higher chance for ED reuse in white as well as nonwhite children covered by public insurance. Hospitalization rate was not dependent on the combination of social determinants, but on the number of post-discharge ED revisits. The combined effect of race/ethnicity and health insurance are associated with post-discharge utilization of ED services, but not with hospital readmission.
