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Variation in Early Inflammatory Marker Testing for Infection-Related Hospitalizations in Children

Jessica L Markham1,2, Cary W Thurm3, Matt Hall4,3

  • 1Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; jlmarkham@cmh.edu.

Hospital Pediatrics
|September 19, 2020
PubMed

Insights

Inflammatory marker testing varies widely in children

Area of Science:

  • Pediatric healthcare research
  • Clinical diagnostics
  • Healthcare quality improvement

Background:

  • Inflammatory marker testing, including C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), is a common diagnostic tool in pediatric infections.
  • Concerns exist regarding the potential overuse of these tests in children's hospitals.
  • Understanding testing variation is crucial for optimizing diagnostic practices.

Purpose of the Study:

  • To analyze the variation in early inflammatory marker testing for infection-related hospitalizations among children's hospitals.
  • To investigate the association between testing rates and key hospital outcomes: length of stay (LOS), 30-day readmission rates, and costs.

Main Methods:

  • A cross-sectional study analyzed data from 55,771 infection-related hospitalizations in children (0-17 years) across 48 children's hospitals.
  • Hospitals were categorized into three groups based on adjusted early inflammatory marker testing rates (CRP or ESR) using k-means clustering.
  • Multivariable regression models assessed the relationship between hospital testing groups and patient outcomes.

Main Results:

  • Early inflammatory marker testing occurred in 14.3% of hospitalizations.
  • Significant variation in testing rates was observed across hospitals and infection types.
  • Hospitals with higher testing rates (Group A) had significantly longer adjusted LOS compared to lower-testing groups (B and C), but no differences in readmission rates or costs were found.

Conclusions:

  • Wide variation exists in pediatric inflammatory marker testing practices across children's hospitals.
  • Hospitals demonstrating higher testing rates for one infection tend to exhibit higher rates for others, suggesting a pattern of diagnostic intensity.
  • These findings highlight opportunities for implementing diagnostic stewardship programs to optimize the use of inflammatory markers and potentially reduce length of stay.
Abstract

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