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Assessment of Different Methods for Pediatric Meningitis Dosing Clinical Decision Support
Jeremy S Stultz1, Perry Taylor2, Sean McKenna3
11 College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN, USA.
Background:
Indication-specific medication dosing support is needed to improve pediatric dosing support.
Objective:
To compare the sensitivity and positive predictive value (PPV) of different meningitis dosing alert triggers and dosing error rates between antimicrobials with and without meningitis order sentences.
Methods:
We retrospectively analyzed 4-months of pediatric orders for antimicrobials with meningitis-specific dosing. At the time of the order, it was determined if the antimicrobial was for meningitis management, if a cerebrospinal fluid (CSF) culture was ordered, and if a natural language processing (NLP) system could detect "meningitis" in clinical notes.
Results:
Of 1383 orders, 243 were for the management of meningitis. A CSF culture or NLP combination trigger searching the electronic health record since admission yielded the greatest sensitivity for detecting meningitis management (67.5%, P < 0.01 vs others), but dosing error detection was similar if the trigger only searched 48 hours preceding the order (68.8% vs 62.5%, P = 0.125). Using a CSF culture alone and a 48-hour time frame had a higher PPV versus a combination with a 48-hour time frame (97.1% vs 80.9%, P < 0.001), and both triggers had a higher PPV than others ( P < 0.001). Antimicrobials with meningitis order sentences had fewer dosing errors (19.8% vs 43.2%, P < 0.01). Conclusion and Relevance: A meningitis dosing alert triggered by a combination of a CSF culture or NLP system and a 48-hour triggering time frame could provide reasonable sensitivity and PPV for meningitis dosing errors. Order sentences with indication-specific recommendations may provide additional dosing support, but additional studies are needed.
Insights
Improving pediatric dosing requires better meningitis alert triggers. A combination of cerebrospinal fluid culture or NLP with a 48-hour lookback offers good sensitivity and PPV for dosing errors.
Area of Science:
- Pediatric pharmacology
- Clinical informatics
- Infectious disease management
Background:
- Pediatric medication dosing requires enhanced support, particularly for specific indications like meningitis.
- Current systems may lack precision in identifying appropriate antimicrobial use for pediatric meningitis cases.
Purpose of the Study:
- To evaluate the effectiveness of different alert triggers in identifying meningitis cases and associated dosing errors.
- To compare the sensitivity and positive predictive value (PPV) of various meningitis dosing alert strategies.
- To assess the impact of indication-specific order sentences on antimicrobial dosing error rates in pediatric meningitis management.
Main Methods:
- Retrospective analysis of 1383 pediatric antimicrobial orders over four months.
- Utilized cerebrospinal fluid (CSF) culture orders and natural language processing (NLP) of clinical notes to identify meningitis cases.
- Compared sensitivity and PPV of different alert trigger combinations and time frames for detecting dosing errors.
Main Results:
- A combined trigger of CSF culture or NLP with a 48-hour electronic health record search showed the highest sensitivity (67.5%) for detecting meningitis management.
- A CSF culture trigger with a 48-hour lookback period demonstrated superior PPV (97.1%) for dosing errors compared to other methods.
- Antimicrobials prescribed using meningitis order sentences had significantly lower dosing error rates (19.8%) compared to those without (43.2%).
Conclusions:
- A meningitis dosing alert system combining CSF culture or NLP with a 48-hour lookback period offers a viable strategy for improving pediatric dosing accuracy.
- Indication-specific order sentences can enhance pediatric dosing support by reducing medication errors.
- Further research is warranted to optimize alert systems and explore the full potential of order sentences in pediatric antimicrobial stewardship.
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