Changes in Antiviral Prescribing for Children With Influenza in US Emergency Departments
Tess Stopczynski1, Olla Hamdan2, Justin Z Amarin2
1Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Antiviral prescribing for high-risk children with influenza in emergency departments (EDs) significantly decreased during the COVID-19 pandemic. This decline occurred despite unchanged national guidelines for influenza treatment.
Area of Science:
- Pediatric Emergency Medicine
- Infectious Diseases
- Public Health
Background:
- National guidelines recommend prompt antiviral treatment for children at high risk of severe influenza.
- Antiviral prescribing rates in pediatric emergency departments (EDs) for high-risk children have historically been suboptimal.
Purpose of the Study:
- To compare antiviral prescribing patterns for high-risk pediatric influenza patients in academic EDs before the COVID-19 pandemic (2016-2020) versus the late pandemic period (2021-2023).
Main Methods:
- A multicenter, cross-sectional study analyzed data from 7 US pediatric academic hospitals.
- Included were influenza-positive children (<18 years) presenting to the ED, focusing on those at higher risk of severe influenza from December 2016 to June 2023.
- Mixed-effects logistic regression identified factors associated with prescribing during the late pandemic.
Main Results:
- Of 3378 influenza-positive children, 2514 (74.4%) were high-risk.
- Antiviral prescriptions dropped from 32.2% pre-pandemic to 15.6% in the late pandemic period, a 53% relative decrease.
- Shorter symptom duration (<2 days) and clinical influenza testing were associated with prescribing in the late pandemic.
Conclusions:
- Influenza antiviral prescribing for high-risk children in EDs decreased during the COVID-19 pandemic compared to prepandemic levels.
- This decrease occurred despite consistent treatment guidelines, highlighting a gap in guideline-concordant care.
- Interventions are necessary to improve adherence to antiviral prescribing recommendations for high-risk pediatric influenza patients.
Importance:
Despite national recommendations, antiviral prescribing in emergency departments (EDs) for children at higher risk of severe influenza, such as those younger than 5 years and those with specific underlying conditions, remains low.
Objective:
To assess whether there were changes in antiviral prescribing for children at higher risk of severe influenza in academic pediatric EDs before the COVID-19 pandemic (2016-2020) vs the late pandemic period (2021-2023).
Design, Setting, And Participants:
This multicenter, cross-sectional study included influenza-positive children younger than 18 years presenting to the ED at 1 of 7 US pediatric academic hospitals participating in the Centers for Disease Control and Prevention's New Vaccine Surveillance Network. The analysis focused on children at higher risk of severe influenza seen in the ED from December 1, 2016, to June 30, 2023.
Exposure:
High risk of severe influenza.
Main Outcomes And Measures:
The primary outcome was antiviral prescribing. Children with influenza who met the criteria for higher risk of severe influenza were included. Antiviral prescribing practices were compared across the prepandemic and late pandemic periods. Mixed-effects logistic regression was used to identify factors associated with prescribing during the late pandemic period.
Results:
Of 3378 influenza-positive children (median [IQR] age, 3.9 [1.8-7.2] years), 2514 (74.4%; 1363 male [40.3%]) were classified as having higher risk of severe influenza during the prepandemic and late pandemic periods. Antiviral prescriptions decreased from 32.2% (622 of 1931 children) before the pandemic to 15.6% (91 of 583 children) in the late pandemic period, representing a 53% relative decrease. In the late pandemic period, symptom duration less than 2 days (adjusted odds ratio, 4.08; 95% CI, 2.49-6.71) and clinical influenza testing (adjusted odds ratio, 17.20; 95% CI, 4.08-72.37) were significantly associated with antiviral prescribing.
Conclusions And Relevance:
This multicenter, cross-sectional study of children with influenza in EDs found that, for children at higher risk of severe influenza illness, influenza antiviral prescribing decreased during the COVID-19 pandemic compared with prepandemic levels, despite unchanged treatment guidelines. Interventions are needed to support guideline-concordant prescribing in this population.
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