The influence of chest X-ray results on antibiotic prescription for childhood pneumonia in the emergency department.
Diagnostic techniques and procedures
Emergency medical services
Guideline adherence
Paediatrics
Pneumonia
anti-bacterial agents
Journal
European journal of pediatrics
ISSN: 1432-1076
Titre abrégé: Eur J Pediatr
Pays: Germany
ID NLM: 7603873
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
29
05
2020
accepted:
10
02
2021
revised:
02
02
2021
pubmed:
24
3
2021
medline:
11
8
2021
entrez:
23
3
2021
Statut:
ppublish
Résumé
The aim of this study is to evaluate the influence of chest X-ray (CXR) results on antibiotic prescription in children suspected of lower respiratory tract infections (RTI) in the emergency department (ED). We performed a secondary analysis of a stepped-wedge, cluster randomized trial of children aged 1 month to 5 years with fever and cough/dyspnoea in 8 EDs in the Netherlands (2016-2018), including a 1-week follow-up. We analysed the observational data of the pre-intervention period, using multivariable logistic regression to evaluate the influence of CXR result on antibiotic prescription. We included 597 children (median age 17 months [IQR 9-30, 61% male). CXR was performed in 109/597 (18%) of children (range across hospitals 9 to 50%); 52/109 (48%) showed focal infiltrates. Children who underwent CXR were more likely to receive antibiotics, also when adjusted for clinical signs and symptoms, hospital and CXR result (OR 7.25 [95% CI 2.48-21.2]). Abnormalities on CXR were not significantly associated with antibiotic prescription.Conclusion: Performance of CXR was independently associated with more antibiotic prescription, regardless of its results. The limited influence of CXR results on antibiotic prescription highlights the inferior role of CXR on treatment decisions for suspected lower RTI in the ED. What is Known: • Chest X-ray (CXR) has a high inter-observer variability and cannot distinguish between bacterial or viral pneumonia. • Current guidelines recommend against routine use of CXR in children with uncomplicated respiratory tract infections (RTIs) in the outpatient setting. What is New: • CXR is still frequently performed in non-complex children suspected of lower RTIs in the emergency department • CXR performance was independently associated with more antibiotic prescriptions, regardless of its results, highlighting the inferior role of chest X-rays in treatment decisions.
Identifiants
pubmed: 33754207
doi: 10.1007/s00431-021-03996-2
pii: 10.1007/s00431-021-03996-2
pmc: PMC8346381
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
2765-2772Subventions
Organisme : Innovatiefonds Zorgverzekeraars
ID : B14-205, dossier 2818
Organisme : ZonMw
ID : 836041001
Pays : Netherlands
Informations de copyright
© 2021. The Author(s).
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