Variation in emergency department diagnostic testing and disposition outcomes in pneumonia

Todd A. Florin*, Benjamin French, Joseph J. Zorc, Elizabeth R. Alpern, Samir S. Shah

*Corresponding author for this work

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. Pediatrics 2013;132:237-244

Original languageEnglish (US)
Pages (from-to)237-244
Number of pages8
JournalPediatrics
Volume132
Issue number2
DOIs
StatePublished - Aug 1 2013

Fingerprint

Hospital Emergency Service
Pneumonia
Hospitalization
Routine Diagnostic Tests
Odds Ratio
Confidence Intervals
Pediatrics
Health Information Systems
Blood Cell Count
Cohort Studies
Thorax
Retrospective Studies
Logistic Models
Wounds and Injuries
Infection

Keywords

  • Children
  • Clinical practice variation
  • Diagnostic tests
  • Emergency medicine
  • Health resources
  • Health services research
  • Hospitalization
  • Logistic models
  • Physician practice patterns
  • Pneumonia
  • Radiography
  • Utilization

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Florin, Todd A. ; French, Benjamin ; Zorc, Joseph J. ; Alpern, Elizabeth R. ; Shah, Samir S. / Variation in emergency department diagnostic testing and disposition outcomes in pneumonia. In: Pediatrics. 2013 ; Vol. 132, No. 2. pp. 237-244.
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title = "Variation in emergency department diagnostic testing and disposition outcomes in pneumonia",
abstract = "OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. Pediatrics 2013;132:237-244",
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Variation in emergency department diagnostic testing and disposition outcomes in pneumonia. / Florin, Todd A.; French, Benjamin; Zorc, Joseph J.; Alpern, Elizabeth R.; Shah, Samir S.

In: Pediatrics, Vol. 132, No. 2, 01.08.2013, p. 237-244.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Variation in emergency department diagnostic testing and disposition outcomes in pneumonia

AU - Florin, Todd A.

AU - French, Benjamin

AU - Zorc, Joseph J.

AU - Alpern, Elizabeth R.

AU - Shah, Samir S.

PY - 2013/8/1

Y1 - 2013/8/1

N2 - OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. Pediatrics 2013;132:237-244

AB - OBJECTIVE: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. Pediatrics 2013;132:237-244

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KW - Health resources

KW - Health services research

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KW - Logistic models

KW - Physician practice patterns

KW - Pneumonia

KW - Radiography

KW - Utilization

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