Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children’s Hospitals

Neubauer, Hannah C.; Hall, Matt; Wallace, Sowdhamini S.; Cruz, Andrea T.; Queen, Mary Ann; Foradori, Dana; Aronson, Paul L.; Markham, Jessica L.; Nead, Jennifer; Hester, Gabrielle; McCulloh, Russell J.; Lopez, Michelle A.

doi:10.1542/hpeds.2018-0032

Cited by 8 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We chose not to include regimens with third‐generation cephalosporins or ampicillin, which may have limited the number of included neonates, because these antibiotics are frequently administered during evaluation for invasive bacterial infections 23 . We found a very low occurrence of treatment failure in our study cohort across all three groups, which is consistent with other studies of SSSS that report an overall good prognosis and low recurrence and/or readmission rates 6,16,24 . The low prevalence of treatment failure, however, precluded our ability to detect small differences among antibiotic regimen groups that may exist.…”

Section: Discussionsupporting

confidence: 70%

“…Children with complex chronic medical conditions as classified by Feudtner et al 17 were excluded, since these children may require a different treatment approach than the general pediatric population. In order to decrease diagnostic ambiguity, we excluded children if an alternative dermatologic diagnosis was recorded as a principal or secondary diagnosis (eg, Stevens‐Johnson syndrome or scarlet fever) 16 . Finally, hospitals with fewer than 10 children with SSSS during the study period were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Covariates included age, sex, ethnicity and/or race, payer type, level of care, illness severity, and region. The variable definitions below are in keeping with a prior study of SSSS 16 . Age was categorized as: birth to 59 days, 2 to 11 months, 1 to 4 years (preschool age), 5 to 10 years (school age), and 11 to 18 years (adolescent).…”

Section: Methodsmentioning

confidence: 99%

“…Illness severity was assigned using the All Patient Refined Diagnosis Related Group (APR‐DRG; 3M Corporation, St. Paul, Minnesota) severity levels 19 . In line with a prior study, 16 we defined “low illness severity” as the APR‐DRG minor (1) classification. The moderate (2), major (3), and extreme (4) classifications were defined as “moderate to high illness severity,” since there were very few classifications of major or extreme (<5%) illness severity.…”

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

Neubauer

Hall

Lopez

et al. 2021

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

BACKGROUND: Controversy exists regarding the optimal antibiotic regimen for use in hospitalized children with staphylococcal scalded skin syndrome (SSSS). Various regimens may confer toxin suppression and/or additional coverage for methicillin-susceptible Staphylococcus aureus (MSSA) or methicillin-resistant S aureus (MRSA). OBJECTIVES: To describe antibiotic regimens in hospitalized children with SSSS and examine the association between antistaphylococcal antibiotic regimens and patient outcomes. DESIGN/METHODS: Retrospective cohort study of children hospitalized with SSSS using the Pediatric Health Information System database (2011-2016). Children who received clindamycin monotherapy, clindamycin plus MSSA coverage (eg, nafcillin), or clindamycin plus MRSA coverage (eg, vancomycin) were included. The primary outcome was hospital length of stay (LOS); secondary outcomes were treatment failure and cost. Generalized linear mixed-effects models were used to compare outcomes among antibiotic groups. RESULTS: Of 1,259 children included, 828 children received the most common antistaphylococcal antibiotic regimens: clindamycin monotherapy (47%), clindamycin plus MSSA coverage (33%), and clindamycin plus MRSA coverage (20%). Children receiving clindamycin plus MRSA coverage had higher illness severity (44%) compared with clindamycin monotherapy (28%) and clindamycin plus MSSA (32%) (P = .001). In adjusted analyses, LOS and treatment failure did not differ among the three regimens (P = .42 and P = .26, respectively). Cost was significantly lower for children receiving clindamycin monotherapy and highest in those receiving clindamycin plus MRSA coverage (mean, $4,839 vs $5,348, respectively; P < .001). CONCLUSIONS: In children with SSSS, the addition of MSSA or MRSA coverage to clindamycin monotherapy was associated with increased cost and no incremental difference in clinical outcomes.

show abstract

Section: Discussionsupporting

confidence: 70%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

Neubauer

Hall

Lopez

et al. 2021

Journal of Hospital Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, some studies from the United States used a similar approach to our study but in pediatric ED 17 and inpatient settings. 36,37 For instance, Florin et al 17 evaluated variation in the use of diagnostic tests and its association with hospital admission and 3-day ED revisits in children presenting with community-acquired pneumonia across 36 pediatric hospitals in the United States. The study found 3 ED groups based on test use, including low, moderate, and high test users.…”

Section: Sensitivity Analysesmentioning

confidence: 99%

The NSW Pathology Atlas of Variation: Part II—The Association of Variation in Emergency Department Laboratory Investigations With Outcomes for Patients Presenting With Chest Pain

Wabe

Scowen

Eigenstetter

et al. 2021

Annals of Emergency Medicine

View full text Add to dashboard Cite

Study objective: Laboratory test use varies across emergency departments (EDs), yet little is known about the effect of this variation on outcomes. The aim of this study is 2-fold: to stratify EDs into clusters based on similar test use, and to determine whether the clusters differ in patient operational outcomes among patients presenting to EDs with undifferentiated chest pain.Methods: We conducted a retrospective cohort study of 222,788 patients presenting with undifferentiated chest pain at 44 EDs across New South Wales, Australia, from January 2017 to September 2018. The operational outcomes measured in this study included ED length of stay, hospital admission, the Emergency Treatment Performance target, and 7-and 15-day all-cause and same-cause ED revisit rates. We performed a hierarchic cluster analysis to identify ED clusters and mixed-effects models to determine the association between the clusters and the operational outcomes.Results: Two ED clusters, moderate users (18 EDs) and high users (26 EDs), were identified. After adjustment for confounders, the median ED length of stay was greater by 15.7% (equivalent to 33.4 minutes) in high versus moderate users (95% confidence interval 6.62 to 25.52 minutes), and high users were less likely to achieve the Emergency Treatment Performance target versus moderate users (odds ratio 0.66; 95% confidence interval 0.50 to 0.86). There were no significant differences between the users in hospital admission and ED revisit rates. Conclusion:Our findings suggest that reducing test use may reduce ED length of stay and improve the chance of achieving the Emergency Treatment Performance target. [

show abstract

Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals

Wolf

Hall

Williams

et al. 2022

Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: Children in mental health crises are increasingly admitted to children's hospitals awaiting inpatient psychiatric placement. During hospitalization, patients may exhibit acute agitation prompting pharmacologic restraint use. Objective: To determine hospital-level incidence and variation of pharmacologic restraint use among children admitted for mental health conditions in children's hospitals. Design, Setting, and Participants: We examined data for children (5 to ≤18 years) admitted to children's hospitals with a primary mental health condition from 2018 to 2020 using the Pediatric Health Information System database. Hospital rates of parenteral pharmacologic restraint use per 1000 mental health bed days were determined and compared after adjusting for patient-level and demographic factors. Cluster analysis (k-means) was used to group hospitals based on overall restraint use (rate quartiles) and drug class. Hospital-level factors for pharmacologic restraint use were compared.Results: Of 29,834 included encounters, 3747 (12.6%) had pharmacologic restraint use. Adjusted hospital rates ranged from 35 to 389 pharmacologic restraint use days per 1000 mental health bed days with a mean of 175 (standard deviation: 72). Cluster analysis revealed three hospitals were high utilizers of all drug classes. No significant differences in pharmacologic restraint use were found in the hospital-level analysis.Conclusions: Children's hospitals demonstrate wide variation in pharmacologic restraint rates for mental health hospitalizations, with a 10-fold difference in adjusted rates between highest and lowest utilizers, and high overall utilizers order medications across all drug classes.

show abstract

Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children’s Hospitals

Abstract: For children hospitalized with SSSS, lower use of diagnostic tests was not associated with changes in outcomes. Hospitals with high diagnostic test use may be able to reduce testing without adversely affecting patient outcomes.

Cited by 8 publications

References 41 publications

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

Antibiotic Regimens and Associated Outcomes in Children Hospitalized With Staphylococcal Scalded Skin Syndrome

The NSW Pathology Atlas of Variation: Part II—The Association of Variation in Emergency Department Laboratory Investigations With Outcomes for Patients Presenting With Chest Pain

Pharmacologic restraint use for children experiencing mental health crises in pediatric hospitals

Contact Info

Product

Resources

About