Loading…
Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia
To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits. We conducted a retrospective...
Saved in:
Published in: | Pediatrics (Evanston) 2013-08, Vol.132 (2), p.237-244 |
---|---|
Main Authors: | , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites Items that cite this one |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | cdi_FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3 |
---|---|
cites | cdi_FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3 |
container_end_page | 244 |
container_issue | 2 |
container_start_page | 237 |
container_title | Pediatrics (Evanston) |
container_volume | 132 |
creator | FLORIN, Todd A FRENCH, Benjamin ZORC, Joseph J ALPERN, Elizabeth R SHAH, Samir S |
description | To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits.
We conducted a retrospective cohort study of children aged 2 months to 18 years with ED visits resulting in CAP diagnoses from 2007 to 2010 who were seen at 36 hospitals contributing data to the Pediatric Health Information System. Children with complex chronic conditions, recent hospitalization, trauma, aspiration, or perinatal infection were excluded. Primary outcomes included diagnostic testing, hospitalization, and 3-day ED revisit rates across hospitals. We examined variation in diagnostic testing among hospitals by using multivariable mixed-effects logistic regression.
A total of 100,615 ED visits were analyzed. Complete blood count (median: 28.7%), blood culture (27.9%), and chest radiograph (75.7%) were the most commonly ordered ED diagnostic tests. After adjustment for patient characteristics, significant variation (P < .001) was found for each test examined across hospitals. High test-utilizing hospitals had increased odds of hospitalization compared with low-utilizing hospitals (odds ratio: 1.86 [95% confidence interval: 1.17-2.94]; P = .008). However, differences in the odds of ED revisit between the low- and high-utilizing hospitals were not significant (odds ratio: 1.21 [95% confidence interval: 0.97-1.51]; P = .09).
Emergency departments that use more testing in diagnosing CAP have higher hospitalization rates than lower-utilizing EDs. However, ED revisit rates were not significantly different between high- and low-utilizing EDs. These results suggest an opportunity to reduce diagnostic testing for CAP without negatively affecting outcomes. |
doi_str_mv | 10.1542/peds.2013-0179 |
format | article |
fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_1417534387</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A343467131</galeid><sourcerecordid>A343467131</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3</originalsourceid><addsrcrecordid>eNpdkU1r3DAQhkVpabZprz0WQyn04s3IkizrGDbpBwQ2h7SHXoRWHhsFW3IlG5J_X7m7bSCnAfHMq3d4CHlPYUsFry4mbNO2AspKoFK9IBsKqil5JcVLsgFgtOQA4oy8SekeALiQ1WtyVrFGNsDVhvz6aaIzswu-cL64HjH26O1jcYWTifOIfi6unOl9SLOzxR3m4fvC-DY_pykk93d1v8w2jJjWjFuPyxi8M2_Jq84MCd-d5jn58eX6bvetvNl__b67vCktU3QuZQ2yUh0ayThTTCrKalCtqjmvG1HLynDDmWxBUNVZe2i5tVwasHCoa0mRnZPPx9wpht9LbqhHlywOg_EYlqQpp1Lk7EZm9OMz9D4s0ed2maqEAFWrOlPlkerNgNp5G_yMD_nCYcAedS6_2-vLnMjz_4xmfnvkbQwpRez0FN1o4qOmoFdLerWkV0t6tZQXPpxqLIcR2__4Py0Z-HQCTLJm6KLx1qUnTgqpGs7YHy8hmGQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1425509696</pqid></control><display><type>article</type><title>Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia</title><source>EZB Free E-Journals</source><creator>FLORIN, Todd A ; FRENCH, Benjamin ; ZORC, Joseph J ; ALPERN, Elizabeth R ; SHAH, Samir S</creator><creatorcontrib>FLORIN, Todd A ; FRENCH, Benjamin ; ZORC, Joseph J ; ALPERN, Elizabeth R ; SHAH, Samir S</creatorcontrib><description>To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits.
We conducted a retrospective cohort study of children aged 2 months to 18 years with ED visits resulting in CAP diagnoses from 2007 to 2010 who were seen at 36 hospitals contributing data to the Pediatric Health Information System. Children with complex chronic conditions, recent hospitalization, trauma, aspiration, or perinatal infection were excluded. Primary outcomes included diagnostic testing, hospitalization, and 3-day ED revisit rates across hospitals. We examined variation in diagnostic testing among hospitals by using multivariable mixed-effects logistic regression.
A total of 100,615 ED visits were analyzed. Complete blood count (median: 28.7%), blood culture (27.9%), and chest radiograph (75.7%) were the most commonly ordered ED diagnostic tests. After adjustment for patient characteristics, significant variation (P < .001) was found for each test examined across hospitals. High test-utilizing hospitals had increased odds of hospitalization compared with low-utilizing hospitals (odds ratio: 1.86 [95% confidence interval: 1.17-2.94]; P = .008). However, differences in the odds of ED revisit between the low- and high-utilizing hospitals were not significant (odds ratio: 1.21 [95% confidence interval: 0.97-1.51]; P = .09).
Emergency departments that use more testing in diagnosing CAP have higher hospitalization rates than lower-utilizing EDs. However, ED revisit rates were not significantly different between high- and low-utilizing EDs. These results suggest an opportunity to reduce diagnostic testing for CAP without negatively affecting outcomes.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2013-0179</identifier><identifier>PMID: 23878049</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>Elk Grove Village, IL: American Academy of Pediatrics</publisher><subject>Adolescent ; Biological and medical sciences ; Child ; Child, Preschool ; Childhood pneumonia ; Children & youth ; Cohort Studies ; Community-acquired infections ; Community-Acquired Infections - diagnosis ; Community-Acquired Infections - epidemiology ; Diagnosis ; Diagnostic Tests, Routine - economics ; Diagnostic Tests, Routine - utilization ; Emergency medical care ; Emergency service ; Emergency Service, Hospital - economics ; Emergency Service, Hospital - statistics & numerical data ; Emergency Service, Hospital - utilization ; Female ; General aspects ; Health Services Research ; Hospital emergency services ; Hospitalization ; Hospitalization - economics ; Hospitalization - statistics & numerical data ; Hospitals ; Humans ; Kansas ; Male ; Medical sciences ; Medical tests ; Methods ; Miscellaneous ; Odds Ratio ; Patient outcomes ; Patient Readmission - economics ; Patient Readmission - statistics & numerical data ; Pediatrics ; Pneumonia ; Pneumonia - diagnosis ; Pneumonia - epidemiology ; Pneumonia in children ; Prevention and actions ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Regression analysis ; Retrospective Studies ; Utilization Review</subject><ispartof>Pediatrics (Evanston), 2013-08, Vol.132 (2), p.237-244</ispartof><rights>2014 INIST-CNRS</rights><rights>Copyright American Academy of Pediatrics Aug 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3</citedby><cites>FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27579843$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23878049$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>FLORIN, Todd A</creatorcontrib><creatorcontrib>FRENCH, Benjamin</creatorcontrib><creatorcontrib>ZORC, Joseph J</creatorcontrib><creatorcontrib>ALPERN, Elizabeth R</creatorcontrib><creatorcontrib>SHAH, Samir S</creatorcontrib><title>Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits.
We conducted a retrospective cohort study of children aged 2 months to 18 years with ED visits resulting in CAP diagnoses from 2007 to 2010 who were seen at 36 hospitals contributing data to the Pediatric Health Information System. Children with complex chronic conditions, recent hospitalization, trauma, aspiration, or perinatal infection were excluded. Primary outcomes included diagnostic testing, hospitalization, and 3-day ED revisit rates across hospitals. We examined variation in diagnostic testing among hospitals by using multivariable mixed-effects logistic regression.
A total of 100,615 ED visits were analyzed. Complete blood count (median: 28.7%), blood culture (27.9%), and chest radiograph (75.7%) were the most commonly ordered ED diagnostic tests. After adjustment for patient characteristics, significant variation (P < .001) was found for each test examined across hospitals. High test-utilizing hospitals had increased odds of hospitalization compared with low-utilizing hospitals (odds ratio: 1.86 [95% confidence interval: 1.17-2.94]; P = .008). However, differences in the odds of ED revisit between the low- and high-utilizing hospitals were not significant (odds ratio: 1.21 [95% confidence interval: 0.97-1.51]; P = .09).
Emergency departments that use more testing in diagnosing CAP have higher hospitalization rates than lower-utilizing EDs. However, ED revisit rates were not significantly different between high- and low-utilizing EDs. These results suggest an opportunity to reduce diagnostic testing for CAP without negatively affecting outcomes.</description><subject>Adolescent</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Childhood pneumonia</subject><subject>Children & youth</subject><subject>Cohort Studies</subject><subject>Community-acquired infections</subject><subject>Community-Acquired Infections - diagnosis</subject><subject>Community-Acquired Infections - epidemiology</subject><subject>Diagnosis</subject><subject>Diagnostic Tests, Routine - economics</subject><subject>Diagnostic Tests, Routine - utilization</subject><subject>Emergency medical care</subject><subject>Emergency service</subject><subject>Emergency Service, Hospital - economics</subject><subject>Emergency Service, Hospital - statistics & numerical data</subject><subject>Emergency Service, Hospital - utilization</subject><subject>Female</subject><subject>General aspects</subject><subject>Health Services Research</subject><subject>Hospital emergency services</subject><subject>Hospitalization</subject><subject>Hospitalization - economics</subject><subject>Hospitalization - statistics & numerical data</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Kansas</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Medical tests</subject><subject>Methods</subject><subject>Miscellaneous</subject><subject>Odds Ratio</subject><subject>Patient outcomes</subject><subject>Patient Readmission - economics</subject><subject>Patient Readmission - statistics & numerical data</subject><subject>Pediatrics</subject><subject>Pneumonia</subject><subject>Pneumonia - diagnosis</subject><subject>Pneumonia - epidemiology</subject><subject>Pneumonia in children</subject><subject>Prevention and actions</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Regression analysis</subject><subject>Retrospective Studies</subject><subject>Utilization Review</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><recordid>eNpdkU1r3DAQhkVpabZprz0WQyn04s3IkizrGDbpBwQ2h7SHXoRWHhsFW3IlG5J_X7m7bSCnAfHMq3d4CHlPYUsFry4mbNO2AspKoFK9IBsKqil5JcVLsgFgtOQA4oy8SekeALiQ1WtyVrFGNsDVhvz6aaIzswu-cL64HjH26O1jcYWTifOIfi6unOl9SLOzxR3m4fvC-DY_pykk93d1v8w2jJjWjFuPyxi8M2_Jq84MCd-d5jn58eX6bvetvNl__b67vCktU3QuZQ2yUh0ayThTTCrKalCtqjmvG1HLynDDmWxBUNVZe2i5tVwasHCoa0mRnZPPx9wpht9LbqhHlywOg_EYlqQpp1Lk7EZm9OMz9D4s0ed2maqEAFWrOlPlkerNgNp5G_yMD_nCYcAedS6_2-vLnMjz_4xmfnvkbQwpRez0FN1o4qOmoFdLerWkV0t6tZQXPpxqLIcR2__4Py0Z-HQCTLJm6KLx1qUnTgqpGs7YHy8hmGQ</recordid><startdate>20130801</startdate><enddate>20130801</enddate><creator>FLORIN, Todd A</creator><creator>FRENCH, Benjamin</creator><creator>ZORC, Joseph J</creator><creator>ALPERN, Elizabeth R</creator><creator>SHAH, Samir S</creator><general>American Academy of Pediatrics</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>7X8</scope></search><sort><creationdate>20130801</creationdate><title>Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia</title><author>FLORIN, Todd A ; FRENCH, Benjamin ; ZORC, Joseph J ; ALPERN, Elizabeth R ; SHAH, Samir S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Childhood pneumonia</topic><topic>Children & youth</topic><topic>Cohort Studies</topic><topic>Community-acquired infections</topic><topic>Community-Acquired Infections - diagnosis</topic><topic>Community-Acquired Infections - epidemiology</topic><topic>Diagnosis</topic><topic>Diagnostic Tests, Routine - economics</topic><topic>Diagnostic Tests, Routine - utilization</topic><topic>Emergency medical care</topic><topic>Emergency service</topic><topic>Emergency Service, Hospital - economics</topic><topic>Emergency Service, Hospital - statistics & numerical data</topic><topic>Emergency Service, Hospital - utilization</topic><topic>Female</topic><topic>General aspects</topic><topic>Health Services Research</topic><topic>Hospital emergency services</topic><topic>Hospitalization</topic><topic>Hospitalization - economics</topic><topic>Hospitalization - statistics & numerical data</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Kansas</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical tests</topic><topic>Methods</topic><topic>Miscellaneous</topic><topic>Odds Ratio</topic><topic>Patient outcomes</topic><topic>Patient Readmission - economics</topic><topic>Patient Readmission - statistics & numerical data</topic><topic>Pediatrics</topic><topic>Pneumonia</topic><topic>Pneumonia - diagnosis</topic><topic>Pneumonia - epidemiology</topic><topic>Pneumonia in children</topic><topic>Prevention and actions</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Regression analysis</topic><topic>Retrospective Studies</topic><topic>Utilization Review</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>FLORIN, Todd A</creatorcontrib><creatorcontrib>FRENCH, Benjamin</creatorcontrib><creatorcontrib>ZORC, Joseph J</creatorcontrib><creatorcontrib>ALPERN, Elizabeth R</creatorcontrib><creatorcontrib>SHAH, Samir S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatrics (Evanston)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>FLORIN, Todd A</au><au>FRENCH, Benjamin</au><au>ZORC, Joseph J</au><au>ALPERN, Elizabeth R</au><au>SHAH, Samir S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia</atitle><jtitle>Pediatrics (Evanston)</jtitle><addtitle>Pediatrics</addtitle><date>2013-08-01</date><risdate>2013</risdate><volume>132</volume><issue>2</issue><spage>237</spage><epage>244</epage><pages>237-244</pages><issn>0031-4005</issn><eissn>1098-4275</eissn><coden>PEDIAU</coden><abstract>To describe the variability across hospitals in diagnostic test utilization for children diagnosed with community-acquired pneumonia (CAP) during emergency department (ED) evaluation and to determine if test utilization is associated with hospitalization and ED revisits.
We conducted a retrospective cohort study of children aged 2 months to 18 years with ED visits resulting in CAP diagnoses from 2007 to 2010 who were seen at 36 hospitals contributing data to the Pediatric Health Information System. Children with complex chronic conditions, recent hospitalization, trauma, aspiration, or perinatal infection were excluded. Primary outcomes included diagnostic testing, hospitalization, and 3-day ED revisit rates across hospitals. We examined variation in diagnostic testing among hospitals by using multivariable mixed-effects logistic regression.
A total of 100,615 ED visits were analyzed. Complete blood count (median: 28.7%), blood culture (27.9%), and chest radiograph (75.7%) were the most commonly ordered ED diagnostic tests. After adjustment for patient characteristics, significant variation (P < .001) was found for each test examined across hospitals. High test-utilizing hospitals had increased odds of hospitalization compared with low-utilizing hospitals (odds ratio: 1.86 [95% confidence interval: 1.17-2.94]; P = .008). However, differences in the odds of ED revisit between the low- and high-utilizing hospitals were not significant (odds ratio: 1.21 [95% confidence interval: 0.97-1.51]; P = .09).
Emergency departments that use more testing in diagnosing CAP have higher hospitalization rates than lower-utilizing EDs. However, ED revisit rates were not significantly different between high- and low-utilizing EDs. These results suggest an opportunity to reduce diagnostic testing for CAP without negatively affecting outcomes.</abstract><cop>Elk Grove Village, IL</cop><pub>American Academy of Pediatrics</pub><pmid>23878049</pmid><doi>10.1542/peds.2013-0179</doi><tpages>8</tpages></addata></record> |
fulltext | fulltext |
identifier | ISSN: 0031-4005 |
ispartof | Pediatrics (Evanston), 2013-08, Vol.132 (2), p.237-244 |
issn | 0031-4005 1098-4275 |
language | eng |
recordid | cdi_proquest_miscellaneous_1417534387 |
source | EZB Free E-Journals |
subjects | Adolescent Biological and medical sciences Child Child, Preschool Childhood pneumonia Children & youth Cohort Studies Community-acquired infections Community-Acquired Infections - diagnosis Community-Acquired Infections - epidemiology Diagnosis Diagnostic Tests, Routine - economics Diagnostic Tests, Routine - utilization Emergency medical care Emergency service Emergency Service, Hospital - economics Emergency Service, Hospital - statistics & numerical data Emergency Service, Hospital - utilization Female General aspects Health Services Research Hospital emergency services Hospitalization Hospitalization - economics Hospitalization - statistics & numerical data Hospitals Humans Kansas Male Medical sciences Medical tests Methods Miscellaneous Odds Ratio Patient outcomes Patient Readmission - economics Patient Readmission - statistics & numerical data Pediatrics Pneumonia Pneumonia - diagnosis Pneumonia - epidemiology Pneumonia in children Prevention and actions Public health. Hygiene Public health. Hygiene-occupational medicine Regression analysis Retrospective Studies Utilization Review |
title | Variation in Emergency Department Diagnostic Testing and Disposition Outcomes in Pneumonia |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-23T13%3A29%3A09IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_proqu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Variation%20in%20Emergency%20Department%20Diagnostic%20Testing%20and%20Disposition%20Outcomes%20in%20Pneumonia&rft.jtitle=Pediatrics%20(Evanston)&rft.au=FLORIN,%20Todd%20A&rft.date=2013-08-01&rft.volume=132&rft.issue=2&rft.spage=237&rft.epage=244&rft.pages=237-244&rft.issn=0031-4005&rft.eissn=1098-4275&rft.coden=PEDIAU&rft_id=info:doi/10.1542/peds.2013-0179&rft_dat=%3Cgale_proqu%3EA343467131%3C/gale_proqu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c391t-760729fea7343937913609d9644685672a4a437d0519fccbd4cc47a0c0b6671e3%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1425509696&rft_id=info:pmid/23878049&rft_galeid=A343467131&rfr_iscdi=true |