Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia

Pediatr Infect Dis J. 2012 Oct;31(10):1036-41. doi: 10.1097/INF.0b013e31825f2b10.


Background: Substantial care variation occurs in a number of pediatric diseases.

Methods: We evaluated the variability in healthcare resource utilization and its association with clinical outcomes among children, aged 1-18 years, hospitalized with community-acquired pneumonia (CAP). Each of 29 children's hospitals contributing data to the Pediatric Hospital Information System was ranked based on the proportion of CAP patients receiving each of 8 diagnostic tests. Primary outcome variable was length of stay (LOS), revisit to the emergency department or readmission within 14 days of discharge.

Results: Of 21,213 children hospitalized with nonsevere CAP, median age was 3 years (interquartile range: 1-6 years). Laboratory testing and antibiotic usage varied widely across hospitals; cephalosporins were the most commonly prescribed antibiotic. There were large differences in the processes of care by age categories. The median LOS was 2 days (interquartile range: 1-3 days) and differed across hospitals; 25% of hospitals had median LOS ≥ 3 days. Hospital-level variation occurred in 14-day emergency department visits and 14-day readmission, ranging from 0.9% to 4.9% and from 1.5% to 4.4%, respectively. Increased utilization of diagnostic testing was associated with longer hospital LOS (P = 0.036) but not with probability of 14-day readmission (Spearman ρ = 0.234; P = 0.225). There was an inverse correlation between LOS and 14-day revisit to the emergency department (ρ = -0.48; P = 0.013).

Conclusions: Wide variability occurred in diagnostic testing for children hospitalized with CAP. Increased diagnostic testing was associated with a longer LOS. Earlier hospital discharge did not correlate with increased 14-day readmission. The precise interaction of increased use with longer LOS remains unclear.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Community-Acquired Infections / diagnosis*
  • Community-Acquired Infections / drug therapy*
  • Diagnostic Services / standards
  • Diagnostic Services / statistics & numerical data*
  • Female
  • Health Services Research
  • Hospitals, Pediatric / standards*
  • Humans
  • Infant
  • Length of Stay / statistics & numerical data
  • Male
  • Patient Readmission / statistics & numerical data
  • Pneumonia / diagnosis*
  • Pneumonia / drug therapy*
  • Standard of Care / standards
  • Standard of Care / statistics & numerical data*
  • Treatment Outcome