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Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department.

ABSTRACT: To investigate the utility of blood cultures performed on previously healthy children and adolescents with community-acquired pneumonia (CAP) at a tertiary care hospital emergency department (ED).We reviewed 3235 patients with CAP aged 6 months to 18 years who underwent blood cultures at the ED from 2009 through 2016. CAP was defined according to the International Classification of Diseases, 10th Revision codes for pneumonia and the requirement of antibiotic treatment plus any of the following: radiologically confirmed, hospitalized, or moderate to severe disease. Blood cultures were retrospectively justified by the Infectious Diseases Society of America guidelines. We measured the yield (true positive results of blood culture) and impact (blood culture-directed change in the antibiotic regimen).Of 2705 previously healthy patients with CAP, 833 (30.8%; 95% confidence interval [CI]: 29.1-32.6) underwent blood cultures justified by the current guidelines. We found 12 patients (0.4%; 95% CI: 0.2-0.8) having positive results of blood culture, 7 of whom underwent justified blood cultures. Of these 7 patients, 3 (0.11%; 95% CI: 0.02-0.3) had the yield, Streptococcus pneumoniae. No impact was made in these 3 patients with S pneumoniae.We confirmed a low utility of blood cultures in previously healthy children and adolescents with CAP who were admitted to the ED. This finding suggests the need to refine the current guidelines for obtaining blood cultures in the ED for pediatric CAP.

SUBMITTER: Kwon JH

PROVIDER: S-EPMC5459721 | biostudies-literature | 2017 Jun

REPOSITORIES: biostudies-literature

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Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department.

Kwon Jae Hyun JH Kim Jung Heon JH Lee Jeong-Yong JY Kim Youn-Jung YJ Sohn Chang Hwan CH Lim Kyoung Soo KS Kim Won Young WY

Medicine 20170601 22

To investigate the utility of blood cultures performed on previously healthy children and adolescents with community-acquired pneumonia (CAP) at a tertiary care hospital emergency department (ED).We reviewed 3235 patients with CAP aged 6 months to 18 years who underwent blood cultures at the ED from 2009 through 2016. CAP was defined according to the International Classification of Diseases, 10th Revision codes for pneumonia and the requirement of antibiotic treatment plus any of the following: ...[more]

PMID: 28562556

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Project description:ObjectivesFocused research on pediatric agitation is lacking despite being a common mental and behavioral health (MBH) emergency. Prevalence of pediatric agitation remains unknown, and prior reports may have underestimated the rate of restraint use for pediatric agitation. This is the largest study to provide a focused evaluation of the prevalence and predictors of pediatric agitation and restraint use as well as the emergency department (ED) length of stay (LOS) and admission rates for agitated patients.MethodsWe reviewed records of patients aged ≤18 years with MBH needs who visited the pediatric ED of a tertiary care hospital during a 3-year-period. We identified and ascertained agitated/aggressive patients using documented signs/symptoms, International Classification of Diseases, Tenth Revision codes, and Behavioral Activity Rating Scale scores. We performed descriptive and multivariable analyses using SAS 9.4 (SAS Institute).ResultsOf 10,172 patients with MBH needs, 1408 (13.8%) were agitated/aggressive. Of these (n = 1408), 63.7% were boys, and the mean age was 11.9 years. Among agitated patients, the prevalence of restraint use was 28.7%, with a predominance of pharmacologic restraint with atypical antipsychotics. Non-Hispanic Blacks were more likely to be agitated (adjusted odd ratio [aOR], 1.8; 95% CI, 1.2-2.7), but not restrained (aOR, 0.8; 95% CI, 0.3-1.8). Predictors of restraint use include history of attention deficit hyperactivity disorder (aOR, 2.2; 95% CI, 1.5-3.3), autism (aOR, 2.9; 95% CI, 1.9-4.5), conduct disorder (aOR, 1.7; 95% CI, 1.2-2.5), psychosis (aOR, 14.3; 95% CI, 2.5-271.8), and substance use/overdose states (aOR, 1.9; CI, 1.2-3.2). Restrained agitated patients had longer ED LOS (8.4 vs 5.0 hours; P < 0.0001) and higher admission rates (aOR, 2.6; 95% CI, 2.0-3.5). Depression (aOR, 0.4; 95% CI, 0.3-0.5) and suicidality (aOR, 0.2; 95% CI, 0.1-0.3) were protective against agitation and restraint use.ConclusionPrevalence of acute agitation and restraint use in pediatric EDs may be much higher than previously reported. Predictors of acute agitation and restraint use among MBH patients were consistent with prior reports. Restrained agitated patients had longer ED LOS and higher admission rates.

Project description:IntroductionPneumonia is a frequent and costly cause of emergency department (ED) visits and hospitalisations in children. There are no evidence-based, validated tools to assist physicians in management and disposition decisions for children presenting to the ED with community-acquired pneumonia (CAP). The objective of this study is to develop a clinical prediction model to accurately stratify children with CAP who are at risk for low, moderate and severe disease across a global network of EDs.Methods and analysisThis study is a prospective cohort study enrolling up to 4700 children with CAP at EDs at ~80 member sites of the Pediatric Emergency Research Networks (PERN; https://pern-global.com/). We will include children aged 3 months to <14 years with a clinical diagnosis of CAP. We will exclude children with hospital admissions within 7 days prior to the study visit, hospital-acquired pneumonias or chronic complex conditions. Clinical, laboratory and imaging data from the ED visit and hospitalisations within 7 days will be collected. A follow-up telephone or text survey will be completed 7-14 days after the visit. The primary outcome is a three-tier composite of disease severity. Ordinal logistic regression, assuming a partial proportional odds specification, and recursive partitioning will be used to develop the risk stratification models.Ethics and disseminationThis study will result in a clinical prediction model to accurately identify risk of severe disease on presentation to the ED. Ethics approval was obtained for all sites included in the study. Cincinnati Children's Hospital Institutional Review Board (IRB) serves as the central IRB for most US sites. Informed consent will be obtained from all participants. Results will be disseminated through international conferences and peer-reviewed publications. This study overcomes limitations of prior pneumonia severity scores by allowing for broad generalisability of findings, which can be actively implemented after model development and validation.

Dataset Information

Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department.

Publications

Low utility of blood culture in pediatric community-acquired pneumonia: An observational study on 2705 patients admitted to the emergency department.

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