Guideline-Concordant Antiviral Treatment in Children at High Risk for Influenza Complications
James W Antoon1,2, Matt Hall3, James A Feinstein4
1Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee, USA.
Insights
National guidelines recommend prompt antiviral treatment for high-risk children with influenza. However, a study found 42% of these vulnerable children did not receive recommended antiviral medication, indicating a gap in care.
Area of Science:
- Pediatric Infectious Diseases
- Public Health
- Clinical Practice Guidelines
Background:
- National guidelines advocate for antiviral treatment in high-risk children with influenza, irrespective of symptom duration.
- There is limited understanding regarding the clinical practice adherence to these recommendations.
Purpose of the Study:
- To assess the concordance of clinical practice with national guidelines for antiviral treatment in high-risk children diagnosed with influenza.
- To identify patient- and provider-level factors influencing guideline-concordant antiviral dispensing.
Main Methods:
- A cross-sectional study analyzed outpatient children (1-18 years) diagnosed with influenza during 2016-2019.
- High-risk status was defined by age, comorbidities, and long-term care facility residence.
- Multivariable logistic regression identified factors associated with antiviral treatment within 2 days of diagnosis.
Main Results:
- Over 274,000 high-risk children with influenza were studied; 58.1% received antiviral treatment.
- Asthma, immunosuppression, and complex chronic conditions were associated with increased antiviral use.
- Younger age (2-5 years), residence in chronic care facilities, and emergency department encounters were linked to decreased antiviral treatment.
Conclusions:
- A significant proportion (42%) of high-risk children with influenza did not receive guideline-recommended antiviral treatment.
- Barriers to the appropriate use of antivirals in this vulnerable pediatric population require further investigation.
Background:
National guidelines recommend antiviral treatment for children with influenza at high risk for complications regardless of symptom duration. Little is known about concordance of clinical practice with this recommendation.
Methods:
We performed a cross-sectional study of outpatient children (aged 1-18 years) at high risk for complications who were diagnosed with influenza during the 2016-2019 influenza seasons. High-risk status was determined using an existing definition that includes age, comorbidities, and residence in a long-term care facility. The primary outcome was influenza antiviral dispensing within 2 days of influenza diagnosis. We determined patient- and provider-level factors associated with guideline-concordant treatment using multivariable logistic regression.
Results:
Of the 274 213 children with influenza at high risk for influenza complications, 159 350 (58.1%) received antiviral treatment. Antiviral treatment was associated with the presence of asthma (aOR, 1.13; 95% confidence interval [CI], 1.11-1.16), immunosuppression (aOR, 1.10; 95% CI, 1.05-1.16), complex chronic conditions (aOR, 1.04; 95% CI, 1.01-1.07), and index encounter in the urgent care setting (aOR, 1.3; 95% CI, 1.26-1.34). Factors associated with decreased odds of antiviral treatment include age 2-5 years compared with 6-17 years (aOR, 0.95; 95% CI, .93-.97), residing in a chronic care facility (aOR, .61; 95% CI, .46-.81), and index encounter in an emergency department (aOR, 0.66; 95% CI, .63-.71).
Conclusions:
Among children with influenza at high risk for complications, 42% did not receive guideline-concordant antiviral treatment. Further study is needed to elucidate barriers to appropriate use of antivirals in this vulnerable population.
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