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[Transferability of trial results into clinical practice: examples taken from paediatric practice]

Johannes Forster1

  • 1St. Josefskrankenhaus (Akademisches Lehrkrankenhaus) und Zentrum für Kinder- und Jugendmedizin, Albert-Ludwigs-Universität Freiburg. Johannes.Forster@rkk-sjk.de

Zeitschrift Fur Evidenz, Fortbildung Und Qualitat Im Gesundheitswesen
|October 21, 2009
PubMed

Insights

Chest X-rays are unnecessary for diagnosing uncomplicated lower respiratory tract infections in children, even with respiratory syncytial virus (RSV). Despite evidence, German hospitals continue to use X-rays, potentially for financial gain within the Diagnosis Related Groups system.

Area of Science:

  • Pediatrics
  • Radiology
  • Public Health

Background:

  • Evidence since 2000 indicates chest X-rays are unnecessary for uncomplicated pediatric lower respiratory tract infections.
  • Diagnosis and initial treatment decisions are not influenced by chest X-rays in these cases, particularly for respiratory syncytial virus (RSV) infections.

Purpose of the Study:

  • To investigate the continued use of chest X-rays in infants and children with uncomplicated lower respiratory tract infections in Germany.
  • To explore potential reasons for the discrepancy between evidence-based guidelines and clinical practice.

Main Methods:

  • Analysis of epidemiological data from Germany.
  • Review of diagnostic and therapeutic decision-making processes.
  • Examination of the German Diagnosis Related Groups (DRG) reimbursement system.

Main Results:

  • Epidemiological studies in Germany show ongoing use of chest X-rays for uncomplicated lower respiratory tract infections in children.
  • This practice may be linked to the German DRG system, where pneumonia diagnoses yield higher hospital reimbursement than bronchiolitis.

Conclusions:

  • The continued use of chest X-rays in pediatric lower respiratory tract infections in Germany appears to be driven by financial incentives within the DRG system, rather than clinical necessity.
  • There is a need to align clinical practice with evidence-based guidelines to ensure appropriate resource utilization and patient care.

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