171. Implementation and Impact of a Consensus Diagnostic and Management Algorithm for Complicated Pneumonia in Children
Session: Oral Abstract Session: Pediatric Pneumonia
Friday, October 21, 2011: 11:45 AM
Room: 156ABC
Background: Variable treatment exists for children with bacterial pneumonia complications such as pleural effusion and empyema.  Sub-specialists at an urban academic tertiary children’s hospital created a literature-based diagnosis and management algorithm for pediatric complicated pneumonia. Goals of implementation included reduction of radiation exposure and evaluation of impact on surgical intervention, length of stay (LOS), readmission rate, antimicrobial use and pathogen identification.

Methods: A cross-sectional study was undertaken in children (3 months to 20 years) with principal or secondary diagnoses codes for empyema and/or pleural effusion in conjunction with bacterial pneumonia.  Study cohorts consisted of subjects admitted 15 months before (Cohort 1, n=83) and after (Cohort 2, n=87) algorithm implementation. Data was collected using clinical and financial data systems. Statistical analysis included χ2 test, linear/ordinal regression and ANOVA.

 Results: Age (p=0.56), gender (p=0.30), diagnoses (p=0.12), and severity level (p=0.84) were similar between cohorts. There was a significant decrease in CT use in Cohort 2 (Cohort 1: 60% vs Cohort 2: 17.2%; p=0.001) and reduction in readmission rate (7.7% vs 0%; p=0.01) and VATS procedures (44.6% vs 28.7; p=0.03), without concomitant increases in vancomycin use (34.9% vs 34.5%; p=0.95) or hospital LOS (6.4 vs 7.6 days; p=0.4).  Amongst patients receiving VATS (N=57), there were no significant differences between cohorts in median time from admission to VATS (2 days; p = 0.29) or median duration of chest tube drainage (3 vs 4 days; p= 0.10). There was a statistically nonsignificant trend for a higher rate of pathogen identification in Cohort 2 (Cohort 1: 33% vs Cohort 2: 54.1%; p=0.12); Streptococcus pneumoniae was the most commonly identified pathogen in both cohorts (37.5% vs 27%; p = 0.23). 

 Conclusion: Implementation of an institutional complicated pneumonia management algorithm reduced CT scan use/radiation exposure, VATS and readmission rate in children diagnosed with pleural infection, without associated increases in LOS or vancomycin use.  This algorithm provides the framework for future prospective quality improvement studies in pediatric patients with complicated pneumonia.

Subject Category: P. Pediatric and perinatal infections

Dinesh Pillai, MD1,2, Xiaoyan Song, PhD, MBBS1,2, William Pastor, MHA, MPH1, Mary Ottolini, MD1,2, David Powell, MD1,2, Bernhard Wiedermann, MD, MA1,2 and Roberta DeBiasi, MD1,2, (1)Children's National Medical Center, Washington, DC, (2)George Washington University School of Medicine, Washington, DC


D. Pillai, None

X. Song, None

W. Pastor, None

M. Ottolini, None

D. Powell, None

B. Wiedermann, None

R. DeBiasi, Celexa: Consultant, None of the above

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