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Following the (Clinical Decision) Rules: Opportunities for Improving Safety and Resource Utilization With the
Philip A Hagedorn1, Samir S Shah2, Eric S Kirkendall2
1Division of Hospital Medicine, Cincinnati Children's Hospital and Medical Center Cincinnati, Ohio philip.hagedorn@cchmc.org.
Insights
The Bacterial Meningitis Score can safely identify children at very low risk for bacterial meningitis. Applying this score could prevent unnecessary hospitalizations, reducing patient risk and healthcare costs.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Disease Diagnostics
Background:
- The Bacterial Meningitis Score accurately identifies children with cerebrospinal fluid (CSF) pleocytosis at very low risk (VLR) for bacterial meningitis.
- Despite the score's accuracy and declining bacterial meningitis incidence, many children with CSF pleocytosis are hospitalized, leading to potential risks and costs.
Purpose of the Study:
- To evaluate the safety and value of hospitalizing children classified as VLR by the Bacterial Meningitis Score.
- To characterize drug exposure, radiologic studies, and costs associated with VLR admissions.
Main Methods:
- A cross-sectional study of 1049 patients with suspected meningitis evaluated between January 2010 and May 2013.
- Analysis of hospitalizations for VLR patients to assess antibiotic duration, drug/radiology exposure, safety events, and costs.
Main Results:
- Twenty VLR patients were hospitalized, receiving an average of 35 hours of antibiotic therapy.
- These hospitalizations resulted in 1 adverse drug event and 1 safety event.
Conclusions:
- Hospitalizing VLR patients exposes them to unnecessary risks and costs.
- Systematic application of the Bacterial Meningitis Score can prevent these avoidable exposures and expenditures.
Background:
The Bacterial Meningitis Score accurately classifies children with cerebrospinal fluid (CSF) pleocytosis at very low risk (VLR) versus not very low risk (non-VLR) for bacterial meningitis. Most children with CSF pleocytosis detected during emergency department evaluation are hospitalized despite the high accuracy of this prediction rule and the decreasing incidence of bacterial meningitis. The lack of widespread use of this rule may contribute to unnecessary risk exposure and costs.
Methods:
This cross-sectional study included 1049 patients who, between January 2010 and May 2013, had suspicion for meningitis and underwent both a complete blood cell count and CSF studies during their emergency department evaluation. We then examined their hospitalizations to characterize exposure to drugs, radiologic studies, and the costs associated with their care to determine the safety and value repercussions of these VLR admissions. Primary outcomes include duration of antibiotics, exposure to drugs and radiology studies, safety events, and costs incurred during these VLR admissions.
Results:
Twenty patients classified as VLR were admitted to the hospital. On average they received 35 hours of antibiotic therapy. There was 1 adverse drug event and 1 safety event.
Conclusions:
The VLR patients admitted to the hospital were exposed to risk and costs despite their low risk stratification. Systematic application of the Bacterial Meningitis Score could prevent these exposures and costs.
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