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Antibiotic and Diagnostic Discordance Between ED Physicians and Hospitalists for Pediatric Respiratory Illness

Eric R Coon1, Christopher G Maloney2, Mark W Shen3

  • 1Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine, Primary Children's Hospital, Salt Lake City, Utah; and eric.coon@hsc.utah.edu.

Hospital Pediatrics
|March 4, 2015
PubMed
Abstract

Insights

Disagreements in diagnosing bacterial respiratory illness and prescribing antibiotics exist between emergency department and pediatric hospitalist physicians. Pediatric hospitalists frequently altered or stopped antibiotics initiated in the emergency department.

Area of Science:

  • Pediatric Medicine
  • Infectious Diseases
  • Healthcare Quality

Background:

  • Accurate diagnosis of bacterial infections in pediatric respiratory illness is challenging due to imperfect diagnostic tools.
  • This diagnostic uncertainty complicates decisions regarding antibiotic prescribing in hospitalized children.
  • Variations in clinical judgment between emergency department (ED) and pediatric hospitalist physicians can lead to treatment discrepancies.

Purpose of the Study:

  • To quantify diagnostic disagreements between ED and pediatric hospitalist physicians for children admitted with respiratory illness.
  • To assess antibiotic prescribing discordance between ED and pediatric hospitalist physicians for pediatric respiratory admissions.

Main Methods:

  • A manual chart review was conducted for children admitted with respiratory illness during winter and summer seasons.
  • Diagnoses were categorized as bacterial, viral, or asthma.
  • Testing, diagnostic, and antibiotic prescribing decisions were analyzed.

Main Results:

  • Significant diagnostic discordance was observed across all respiratory illness categories, most notably for bacterial infections (P<.001).
  • Antibiotic prescribing discordance was also significant (P<.001).
  • Pediatric hospitalists modified antibiotic therapy for 93% of patients initially prescribed antibiotics in the ED, discontinuing them in 62%.

Conclusions:

  • Substantial diagnostic and antibiotic prescribing discrepancies exist between emergency department and pediatric hospitalist physicians for hospitalized children with respiratory illness.
  • These findings highlight a need for improved diagnostic accuracy and standardized treatment protocols to optimize antibiotic use in pediatric respiratory care.
Keywords:
antimicrobial resistancecommunity-acquired and nosocomial pneumoniadiagnostic decision-makinghospitalistpediatrics

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