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Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children's
Hannah C Neubauer1, Matt Hall2, Sowdhamini S Wallace3
1Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; hcneubau@texaschildrens.org.
Insights
The incidence of staphylococcal scalded skin syndrome (SSSS) is rising, but diagnostic test use varies widely in hospitalized children. Lower diagnostic test use was not associated with adverse patient outcomes, suggesting potential for reduced testing.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnostics
- Health Services Research
Background:
- Staphylococcal scalded skin syndrome (SSSS) incidence is increasing, with significant variation in diagnostic practices.
- Understanding diagnostic test utilization in pediatric SSSS hospitalizations is crucial for optimizing care.
Purpose of the Study:
- To describe the variation in diagnostic test use among children hospitalized with SSSS.
- To determine if diagnostic test use is associated with patient outcomes.
Main Methods:
- Retrospective cohort study of 1259 children (0-18 years) hospitalized with SSSS from 2011-2016.
- Hospitals were clustered into high and low diagnostic test use groups.
- Outcomes analyzed included length of stay, cost, readmissions, and ED revisits.
Main Results:
- Significant interhospital variation in diagnostic testing was observed, particularly for inflammatory markers.
- Blood culture was the most frequently used test (62%-100%).
- No significant differences in length of stay, cost, readmission, or ED revisit rates were found between high and low test use groups.
Conclusions:
- Lower diagnostic test utilization in pediatric SSSS cases was not linked to adverse patient outcomes.
- Hospitals with high diagnostic test use may be able to reduce testing without negatively impacting patient outcomes.
Objectives:
The incidence of staphylococcal scalded skin syndrome (SSSS) is rising, but current practice variation in diagnostic test use is not well described. Our aim was to describe the variation in diagnostic test use in children hospitalized with SSSS and to determine associations with patient outcomes.
Methods:
We performed a retrospective (2011-2016) cohort study of children aged 0 to 18 years from 35 children's hospitals in the Pediatric Health Information System database. Tests included blood culture, complete blood count, erythrocyte sedimentation rate, C-reactive protein level, serum chemistries, and group A streptococcal testing. K-means clustering was used to stratify hospitals into groups of high (cluster 1) and low (cluster 2) test use. Associations between clusters and patient outcomes (length of stay, cost, readmissions, and emergency department revisits) were assessed with generalized linear mixed-effects modeling.
Results:
We included 1259 hospitalized children with SSSS; 84% were ≤4 years old. Substantial interhospital variation was seen in diagnostic testing. Blood culture was the most commonly obtained test (range 62%-100%), with the most variation seen in inflammatory markers (14%-100%). Between hospital clusters 1 and 2, respectively, there was no significant difference in adjusted length of stay (2.6 vs 2.5 days; P = .235), cost ($4752 vs $4453; P = .591), same-cause 7-day readmission rate (0.8% vs 0.4%; P = .349), or emergency department revisit rates (0.1% vs 0.6%; P = .148).
Conclusions:
For children hospitalized with SSSS, lower use of diagnostic tests was not associated with changes in outcomes. Hospitals with high diagnostic test use may be able to reduce testing without adversely affecting patient outcomes.
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