Variations in Pediatric Pneumonia and Bronchitis/Asthma Admission Rates

Payne, Susan N.; Donahue, Charles L.; Rappo, Peter D.; McNamara, John J.; Bass, Joel L.; First, Lewis; Kulig, John W.; Palfrey, Sean; Siegel, Benjamin; Homer, Charles J.

doi:10.1001/archpedi.1995.02170140044006

Cited by 30 publications

(16 citation statements)

References 30 publications

(2 reference statements)

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“…In a US study where 9.4% of paediatric pneumonia admissions were ''inappropriate'', such admissions subsequently reduced after study results were fed back. 13 Admission itself is costly both to the NHS and to the family, and should be avoided where possible.…”

Section: Discussionmentioning

confidence: 99%

Children with pneumonia: how do they present and how are they managed?

Clark

Hammal

Spencer

et al. 2007

Archives of Disease in Childhood

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Objective: To describe the spectrum of clinical features and management of community acquired pneumonia in the UK. Design: Prospectively recorded clinical details for all children with possible pneumonia and chest x ray (CXR) changes in 13 hospitals in the North of England between 2001 and 2002. Results: 89% of 711 children presenting to hospital with pneumonia were admitted; 96% received antibiotics, 70% intravenously. 20% had lobar CXR changes, 3% empyema and 4% required intensive care. Respiratory rate (RR), hypoxia and dyspnoea all correlated with each other and prompted appropriate interventions. Admission in children, not infants, was independently associated with RR, oxygen saturation, lobar CXR changes and pyrexia. Neither C-reactive protein, lobar CXR changes or pyrexia were associated with severity. Children over 1 year old with perihilar CXR changes more often had severe disease (p = 0.001). Initial intravenous antibiotics were associated with lobar CXR changes in infants and children and with dyspnoea, pyrexia and pleural effusion in children. The presence of pleural effusion increased duration of antibiotic treatment (p,0.001). Cefuroxime was the most often used intravenous antibiotic in 61%. Oral antibiotics included a penicillin in 258 (46%), a macrolide in 192 (34%) and a cephalosporin in 117 (21%). Infants stayed significantly longer (p,0.001) as did children with severe disease (p,0.01), effusions (p = 0.005) or lobar CXR changes (p(0.001).Conclusions: There is a high rate of intravenous antibiotic administration in hospital admissions for pneumonia. Despite lobar CXR changes not being independently associated with severe disease, initial lobar CXR changes and clinical assessment in children independently influenced management decisions, including admission and route of antibiotics.

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Section: Discussionmentioning

confidence: 99%

Children with pneumonia: how do they present and how are they managed?

Clark

Hammal

Spencer

et al. 2007

Archives of Disease in Childhood

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“…Although variations in hospital admission rates have been documented, these variations have been predominantly attributed to differences in asthma severity, daily prophylaxis, intensity of emergency treatment, and admission criteria. 37 38 Clearly, important international variations in these factors could influence the anticipated response to treatment.…”

Section: Methodsmentioning

confidence: 99%

Should inhaled anticholinergics be added to beta 2 agonists for treating acute childhood and adolescent asthma? A systematic review

Plotnick

Ducharme

1998

BMJ

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Objectives To estimate the therapeutic and adverse effects of addition of inhaled anticholinergics to 2 agonists in acute asthma in children and adolescents. Design Systematic review of randomised controlled trials of children and adolescents taking 2 agonists for acute asthma with or without the addition of inhaled anticholinergics. Main outcome measures Hospital admission, pulmonary function tests, number of nebulised treatments, relapse, and adverse effects. Results Of 37 identified trials, 10 were relevant and six of these were of high quality. The addition of a single dose of anticholinergic to 2 agonist did not reduce hospital admission (relative risk 0.93, 95% confidence interval 0.65 to 1.32). However, significant group differences in lung function supporting the combination treatment were observed 60 minutes (standardised mean difference − 0.57, − 0.93 to − 0.21) and 120 minutes ( − 0.53, − 0.90 to − 0.17) after the dose of anticholinergic. In contrast, the addition of multiple doses of anticholinergics to 2 agonists, mainly in children and adolescents with severe exacerbations, reduced the risk of hospital admission by 30% (relative risk 0.72, 0.53 to 0.99). Eleven (95% confidence interval 5 to 250) children would need to be treated to avoid one admission. A parallel improvement in lung function (standardised mean difference − 0.66, − 0.95 to − 0.37) was noted 60 minutes after the last combined inhalation.

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“…or NTHi) together accounted for over 90% of the Government cost of admissions, and pneumococcal meningitis and bacteraemia jointly accounted for only 7.5%. Other studies in NZ [47,48] and abroad [17,49,50] have shown that all-cause pneumonia is responsible for a considerable disease burden among children, and is associated with high paediatric hospital admission rates.…”

Section: Admissionsmentioning

confidence: 99%

Burden and Cost of Hospital Admissions for Vaccine-Preventable Paediatric Pneumococcal Disease and Non-Typable Haemophilus influenzae Otitis Media in New Zealand

Milne

Hoorn

2010

Applied Health Economics and Health Policy

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Prior to the introduction of a national Sp. immunization programme, hospital admissions for Sp. disease and NTHi otitis media in NZ cost about $NZ10 million annually, mostly for children aged<2 years and particularly for those living in relative socioeconomic deprivation and for Pacific Island and Māori children. There were about five pneumococcal deaths annually. With adjustment for local serotypes, vaccine serotype coverage and uptake, immunization with any of the three available pneumococcal vaccines would reduce this burden substantially.

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Variations in Pediatric Pneumonia and Bronchitis/Asthma Admission Rates

Cited by 30 publications

References 30 publications

Children with pneumonia: how do they present and how are they managed?

Children with pneumonia: how do they present and how are they managed?

Should inhaled anticholinergics be added to beta 2 agonists for treating acute childhood and adolescent asthma? A systematic review

Burden and Cost of Hospital Admissions for Vaccine-Preventable Paediatric Pneumococcal Disease and Non-Typable Haemophilus influenzae Otitis Media in New Zealand

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