Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2012 Nov;130(5):e823-30.
doi: 10.1542/peds.2012-1285. Epub 2012 Oct 22.

Influence of hospital guidelines on management of children hospitalized with pneumonia

Mark I Neuman  1 , Matt Hall, Adam L Hersh, Thomas V Brogan, Kavita Parikh, Jason G Newland, Anne J Blaschke, Derek J Williams, Carlos G Grijalva, Amy Tyler, Samir S Shah
Affiliations
Multicenter Study

Influence of hospital guidelines on management of children hospitalized with pneumonia

Mark I Neuman et al. Pediatrics. 2012 Nov.

Abstract

Background and objective: Clinical practice guidelines (CPGs) assist clinicians in making appropriate diagnostic and treatment decisions based on available evidence. The objective of this study was to describe the availability and content of institutional community-acquired pneumonia (CAP) CPGs, and to evaluate the association between institutional CPGs and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP.

Methods: This multicenter retrospective cohort study included children aged 1 to 18 years hospitalized with CAP from July 1, 2009, to June 30, 2011. CPGs from each institution were reviewed to abstract information regarding diagnostic testing and antimicrobial selection. We compared overall and specific utilization patterns, antimicrobial use, and hospital length of stay (LOS) for children with CAP between hospitals with and without CPGs.

Results: Thirteen (31.7%) of 41 hospitals had an institutional CPG for nonsevere CAP. There was marked heterogeneity among CPGs. Among the 19,710 children hospitalized with CAP, cost of care, hospital LOS, and 14-day readmission rate were not associated with the presence of a CPG. CPGs did not influence ordering patterns for most diagnostic tests, including blood culture and chest radiographs. Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a CPG recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a CPG (odds ratio = 2.7; 95% confidence interval = 1.4-5.5).

Conclusions: The availability of a CAP CPG had minimal impact on resource utilization and was not associated with cost or hospital LOS. Institutional CPGs, however, did influence patterns of antimicrobial use.

PubMed Disclaimer

Conflict of interest statement

FINANCIAL DISCLOSURE: Dr Hall is an employee of Children’s Hospital Association, the owner of the Pediatric Health Information System database that was used in this study; the other authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

FIGURE 1. Flow diagram of study cohort. CCC, chronic comorbid condition.
FIGURE 1
Flow diagram of study cohort. CCC, chronic comorbid condition.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Brogan TV , Hall M , Williams DJ , et al. . Variability in processes of care and outcomes among children hospitalized with community-acquired pneumonia [published online ahead of print May 30, 2012]. Pediatr Infect Dis J. doi:10.1097/INF.0b013e31825f2b10 - PMC - PubMed
    1. Ambroggio L , Tabb LP , O’Meara T , Sheffler-Collins S , McGowan KL , Shah SS . Influence of antibiotic susceptibility patterns on empiric antibiotic prescribing for children hospitalized with community-acquired pneumonia. Pediatr Infect Dis J. 2012;31(4):331–336 - PMC - PubMed
    1. Hersh AL , Shapiro DJ , Newland JG , Polgreen PM , Beekmann SE , Shah SS . Variability in pediatric infectious disease consultants’ recommendations for management of community-acquired pneumonia. PLoS ONE. 2011;6(5):e20325 - PMC - PubMed
    1. Conway PH , Keren R . Factors associated with variability in outcomes for children hospitalized with urinary tract infection. J Pediatr. 2009;154(6):789–796 - PubMed
    1. Tieder JS , Robertson A , Garrison MM . Pediatric hospital adherence to the standard of care for acute gastroenteritis. Pediatrics. 2009;124(6). Available at: www.pediatrics.org/cgi/content/full/124/6/ e1081 - PubMed

Publication types

Substances