Wide variation exists in ED testing for pneumonia

July 30, 2013

Wide variation exists in the amount of testing performed by emergency departments (EDs) to diagnose pediatric pneumonia. Although EDs that test more have higher rates of hospitalization, comparable ED revisit rates indicate that maybe all that testing isn’t necessary.

 

Wide variation exists in the amount of testing performed by emergency departments (EDs) to diagnose pediatric pneumonia. Although EDs that test more have higher rates of hospitalization, comparable ED revisit rates indicate that maybe all that testing isn’t necessary.

Researchers from Cincinnati and Philadelphia conducted a retrospective cohort study of children aged 2 months to 18 years who received a diagnosis of community-acquired pneumonia (CAP) from an ED during the period 2007 to 2010. The children visited 1 of 36 hospitals contributing data to the Pediatric Health Information System. The investigators excluded children with complex chronic conditions, recent hospitalization, trauma, aspiration, or perinatal infection.

The researchers analyzed just over 100,000 ED visits. They found that complete blood count, blood culture, and chest radiograph were the most common tests ordered. Hospitals with high test utilization had rates of hospitalization that were almost twice as high as low test-utilizing hospitals. However, ED revisit rates between the 2 groups were not significantly different.

The researchers suggest that maybe an opportunity exists to reduce testing for CAP without negatively affecting health outcomes.

According to the clinical practice guidelines of the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America, children with CAP require hospitalization when they have moderate to severe CAP, as defined by several factors, including respiratory distress and hypoxemia (sustained saturation of peripheral oxygen [SpO2], <90% at sea level); when they are aged younger than 3 to 6 months; when CAP is suspected of being caused by a particularly virulent or resistant bug, such as community-associated methicillin-resistant Staphylococcus aureus; or when a concern exists about appropriate follow-up, administration of therapy, or the receipt of proper care at home.

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