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Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children

Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized...

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Autores principales: Chiotos, Kathleen, Grundmeier, Robert, Meyahnwi, Didien, Dutcher, Lauren, Lautenbach, Ebbing, Neuhauser, Melinda, Hamilton, Keith, Jaskowiak, Anne, Cressman, Leigh, Szymczak, Julia, Muller, Brandi, Gerbe, Jeffrey
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cambridge University Press 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594217/
http://dx.doi.org/10.1017/ash.2023.381
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author Chiotos, Kathleen
Grundmeier, Robert
Meyahnwi, Didien
Dutcher, Lauren
Lautenbach, Ebbing
Neuhauser, Melinda
Hamilton, Keith
Jaskowiak, Anne
Cressman, Leigh
Szymczak, Julia
Muller, Brandi
Gerbe, Jeffrey
author_facet Chiotos, Kathleen
Grundmeier, Robert
Meyahnwi, Didien
Dutcher, Lauren
Lautenbach, Ebbing
Neuhauser, Melinda
Hamilton, Keith
Jaskowiak, Anne
Cressman, Leigh
Szymczak, Julia
Muller, Brandi
Gerbe, Jeffrey
author_sort Chiotos, Kathleen
collection PubMed
description Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized with CAP and to evaluate the appropriateness of initial antibiotic choice and duration. Methods: We performed a cross-sectional study including children 6 months to 17 years hospitalized for CAP between January 1, 2019, and October 31, 2022, at a tertiary-care children’s hospital. CAP was defined electronically as an International Classification of Disease, Tenth Revision (ICD-10) code for pneumonia, a chest radiograph or chest computed tomography scan (CT) performed within 48 hours of admission, and systemic antibiotics administered within the first 48 hours of hospitalization and continued for at least 2 days. We applied the following exclusion criteria: patients transferred from another healthcare setting, those who died within 48 hours of hospitalization, children with complex chronic conditions, and those with intensive care unit stays >48 hours. Criteria for appropriate antibiotic choice and duration were defined based on established guidelines. Two physicians performed independent medical record reviews of 80 randomly selected patients (10% sample) to evaluate the performance of the electronic algorithm in (1) identifying patients treated for clinician-diagnosed CAP and (2) classifying antibiotic choice and duration as appropriate. A third physician resolved discrepancies. The electronic algorithm was compared to this medical record review, which served as the reference standard. Results: Of 80 children identified by the electronic algorithm, 79 (99%) were diagnosed with CAP based on medical record review. Antibiotic use was classified as the appropriate choice in 75 (94%) of 80 cases, and appropriate duration in 16 (20%) of 80 cases. The sensitivity of the electronic algorithm for identifying appropriate initial antibiotic choice was 94%; specificity could not be calculated because no events of inappropriate antibiotic choice were identified based on chart review. The sensitivity and specificity for determining appropriate duration were 88% and 97%, respectively (Table 1). Conclusions: The electronic algorithm accurately identified children hospitalized with CAP and demonstrated acceptable performance for identifying appropriate antibiotic choice and duration. Use of this electronic algorithm may improve the efficiency of stewardship activities and could facilitate alignment with updated accreditation standards. Future studies validating this algorithm at other centers are needed. Disclosures: None
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spelling pubmed-105942172023-10-25 Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children Chiotos, Kathleen Grundmeier, Robert Meyahnwi, Didien Dutcher, Lauren Lautenbach, Ebbing Neuhauser, Melinda Hamilton, Keith Jaskowiak, Anne Cressman, Leigh Szymczak, Julia Muller, Brandi Gerbe, Jeffrey Antimicrob Steward Healthc Epidemiol Antibiotic Stewardship Background: Community-acquired pneumonia (CAP) is a common indication for antibiotic use in hospitalized children and is a key target for pediatric antimicrobial stewardship programs (ASPs). Building upon prior work, we developed and refined an electronic algorithm to identify children hospitalized with CAP and to evaluate the appropriateness of initial antibiotic choice and duration. Methods: We performed a cross-sectional study including children 6 months to 17 years hospitalized for CAP between January 1, 2019, and October 31, 2022, at a tertiary-care children’s hospital. CAP was defined electronically as an International Classification of Disease, Tenth Revision (ICD-10) code for pneumonia, a chest radiograph or chest computed tomography scan (CT) performed within 48 hours of admission, and systemic antibiotics administered within the first 48 hours of hospitalization and continued for at least 2 days. We applied the following exclusion criteria: patients transferred from another healthcare setting, those who died within 48 hours of hospitalization, children with complex chronic conditions, and those with intensive care unit stays >48 hours. Criteria for appropriate antibiotic choice and duration were defined based on established guidelines. Two physicians performed independent medical record reviews of 80 randomly selected patients (10% sample) to evaluate the performance of the electronic algorithm in (1) identifying patients treated for clinician-diagnosed CAP and (2) classifying antibiotic choice and duration as appropriate. A third physician resolved discrepancies. The electronic algorithm was compared to this medical record review, which served as the reference standard. Results: Of 80 children identified by the electronic algorithm, 79 (99%) were diagnosed with CAP based on medical record review. Antibiotic use was classified as the appropriate choice in 75 (94%) of 80 cases, and appropriate duration in 16 (20%) of 80 cases. The sensitivity of the electronic algorithm for identifying appropriate initial antibiotic choice was 94%; specificity could not be calculated because no events of inappropriate antibiotic choice were identified based on chart review. The sensitivity and specificity for determining appropriate duration were 88% and 97%, respectively (Table 1). Conclusions: The electronic algorithm accurately identified children hospitalized with CAP and demonstrated acceptable performance for identifying appropriate antibiotic choice and duration. Use of this electronic algorithm may improve the efficiency of stewardship activities and could facilitate alignment with updated accreditation standards. Future studies validating this algorithm at other centers are needed. Disclosures: None Cambridge University Press 2023-09-29 /pmc/articles/PMC10594217/ http://dx.doi.org/10.1017/ash.2023.381 Text en © The Society for Healthcare Epidemiology of America 2023 https://creativecommons.org/licenses/by/4.0/This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Antibiotic Stewardship
Chiotos, Kathleen
Grundmeier, Robert
Meyahnwi, Didien
Dutcher, Lauren
Lautenbach, Ebbing
Neuhauser, Melinda
Hamilton, Keith
Jaskowiak, Anne
Cressman, Leigh
Szymczak, Julia
Muller, Brandi
Gerbe, Jeffrey
Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title_full Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title_fullStr Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title_full_unstemmed Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title_short Validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
title_sort validation of an electronic algorithm to identify appropriate antibiotic use for community-acquired pneumonia in children
topic Antibiotic Stewardship
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10594217/
http://dx.doi.org/10.1017/ash.2023.381
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