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Variation in emergency department diagnostic testing and disposition outcomes in pneumonia

Todd A Florin1, Benjamin French, Joseph J Zorc

  • 1Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA. todd.florin@cchmc.org.

Pediatrics
|July 24, 2013
PubMed

Insights

Hospitals using more diagnostic tests for childhood community-acquired pneumonia (CAP) have higher hospitalization rates. Reducing testing for CAP may not increase emergency department revisits.

Area of Science:

  • Pediatric Emergency Medicine
  • Health Services Research

Background:

  • Community-acquired pneumonia (CAP) is a common pediatric diagnosis in emergency departments (EDs).
  • Significant variability exists in diagnostic test utilization for pediatric CAP across hospitals.
  • The association between diagnostic test utilization and patient outcomes like hospitalization and ED revisits is not well understood.

Purpose of the Study:

  • To describe hospital-level variation in diagnostic test use for pediatric CAP.
  • To determine if diagnostic test utilization is associated with hospitalization and 3-day ED revisits.

Main Methods:

  • Retrospective cohort study of 100,615 children (2 months to 18 years) diagnosed with CAP in EDs from 2007-2010.
  • Data from 36 hospitals in the Pediatric Health Information System.
  • Multivariable mixed-effects logistic regression to examine variation in testing and its association with outcomes, adjusting for patient characteristics.

Main Results:

  • Complete blood count, blood culture, and chest radiograph were common ED tests for pediatric CAP.
  • Significant hospital-level variation (P < .001) was observed for all tested diagnostic procedures.
  • Hospitals with high test utilization showed increased odds of hospitalization (OR: 1.86) compared to low-utilizing hospitals, but no significant difference in 3-day ED revisit rates (OR: 1.21).

Conclusions:

  • Higher diagnostic test utilization for pediatric CAP in EDs is associated with increased hospitalization rates.
  • Reducing diagnostic testing for pediatric CAP may be feasible without adversely impacting ED revisit rates.
  • Findings suggest an opportunity to optimize diagnostic strategies for pediatric CAP in the ED setting.
Abstract

Keywords:
childrenclinical practice variationdiagnostic testsemergency medicinehealth resourceshealth services researchhospitalizationlogistic modelsphysician practice patternspneumoniaradiographyutilization

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