Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia
Florin et al.
Pediatrics August, 2013
This study is a retrospective cohort of children aged 2 months to 18 years seen in the ED with a diagnosis of community acquired pneumonia. The data came from 36 hospitals via a large database (Pediatric Health Information System). Outcomes included:
- Diagnostic testing
- Hospitalization
- 3-day ED revisit rates across hospitals
Exclusion criteria:
- Complex chronic conditions
- Recent hospitalization
- Trauma
- Aspiration
- Perinatal infection
The authors compiled data from 100,615 ED visits. The most commonly ordered tests included
- Complete blood count = 28.7%
- Blood culture = 27.9%
- Chest X-Ray = 75.7%
They noted that the variation across hospitals was significant for each test (P < .001). Hospitals that did more testing had higher admission rates (OR: 1.86
What did I take home from this study?
Well, it is tempting to think of one’s own work on a micro scale, focusing only on the patients that are currently being seen in the department. Certainly we all are aware of the bigger picture as well. This study doesn’t necessarily draw any conclusions for us -what it does suggest, is that there is a need to standardize the care of children with community acquired pneumonia. The Pediatric Infectious Disease Society 2011 recommendations are a great place to start – and would be a lovely article to share with Department leadership. If you already use these guidelines in practice – great, keep it up!
