Acute respiratory illness is the most common reason for hospitalization in children. Antibiotics are recommended for hospitalized children with community‐acquired pneumonia despite an inability to distinguish bacterial from the more common viral etiologies. Chest x‐rays are also frequently ordered in children with asthma and bronchiolitis to look for concomitant pneumonia. As a result, antibiotics are commonly prescribed for respiratory illnesses in hospitalized children. Different approaches to management by emergency department (ED) physicians and hospitalists may result in unnecessary variation surrounding the use of antibiotics in these children. The objective of this study was to measure the frequency with which antibiotic prescribing decisions differed between ED and hospitalist physicians at the time of admission in children with acute respiratory illness.
The charts of consecutive patients admitted to a tertiary‐care children's hospital for respiratory illness were retrospectively reviewed to compare decisions surrounding antibiotic use between the ED and the admitting hospitalist team. Data were collected during 2 periods: a high‐volume winter period and a low‐volume summer period.
Of the 187 patients included, 45 patients (24%; 95% CI, 18%–30%) were prescribed antibiotics by the ED. Of these cases, the admitting hospitalist team made a change to the antibiotic therapy choices in 42 patients (93%; 95% CI, 86%–100%). This included narrowing antibiotic coverage in 9 patients (20%; 95% CI, 8%–32%) and stopping antibiotics altogether in 28 patients (62%; 95% CI, 48%–76%). In patients who had their antibiotics stopped, 70% had a chest x‐ray (CXR) officially read by a radiologist as definite or equivocal pneumonia, and none was transferred to a higher level of care. Of the 142 patients who were not prescribed antibiotics by the ED, only 3 were started on antibiotics by the admitting hospitalist team (2%; 95% CI, 0%–4%). Although potential adverse outcomes were small in number, there were no apparent differences between the groups in terms of transfer to higher level of care, length of stay or 14‐day readmissions.
Hospitalists frequently stop or narrow antibiotics that are started for respiratory illness by the ED. Further exploration of this significant discordance in clinical practice may inform future efforts to improve antibiotic stewardship and reduce overuse of CXRs.
To cite this abstract:Coon E, Shen M. Antibiotic Discordance Between Emergency Physicians and Hospitalists for Children Admitted with Respiratory Illness. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 120. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/antibiotic-discordance-between-emergency-physicians-and-hospitalists-for-children-admitted-with-respiratory-illness/. Accessed April 21, 2019.