Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia

Mona Mostaghim, Tom Snelling, Brendan McMullan, Yean H. Ewe, Beata Bajorek

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Aim: To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP).

    Methods: Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded.

    Results: Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21).

    Conclusion: CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.

    Original languageEnglish
    Pages (from-to)305-311
    Number of pages7
    JournalJournal of Paediatrics and Child Health
    Volume55
    Issue number3
    Early online date30 Aug 2018
    DOIs
    Publication statusPublished - Mar 2019

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    Clinical Decision Support Systems
    Pneumonia
    Anti-Bacterial Agents
    Pediatric Hospitals
    Hospitalized Child

    Cite this

    Mostaghim, Mona ; Snelling, Tom ; McMullan, Brendan ; Ewe, Yean H. ; Bajorek, Beata. / Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia. In: Journal of Paediatrics and Child Health. 2019 ; Vol. 55, No. 3. pp. 305-311.
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    title = "Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia",
    abstract = "Aim: To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). Methods: Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. Results: Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5{\%} (77/134) cases pre-CDSS and 45.8{\%} (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6{\%} pre-CDSS and 54.2{\%} post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3{\%} pre-CDSS, 77.6{\%} post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7{\%} pre-CDSS, 61.7{\%} post-CDSS; P = 0.21). Conclusion: CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.",
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    author = "Mona Mostaghim and Tom Snelling and Brendan McMullan and Ewe, {Yean H.} and Beata Bajorek",
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    Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia. / Mostaghim, Mona; Snelling, Tom; McMullan, Brendan; Ewe, Yean H.; Bajorek, Beata.

    In: Journal of Paediatrics and Child Health, Vol. 55, No. 3, 03.2019, p. 305-311.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia

    AU - Mostaghim, Mona

    AU - Snelling, Tom

    AU - McMullan, Brendan

    AU - Ewe, Yean H.

    AU - Bajorek, Beata

    PY - 2019/3

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    N2 - Aim: To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). Methods: Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. Results: Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21). Conclusion: CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.

    AB - Aim: To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). Methods: Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. Results: Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21). Conclusion: CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.

    KW - anti-infective agent

    KW - child

    KW - community-acquired infection

    KW - physician

    KW - practice guidelines as topic

    KW - practice pattern

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    DO - 10.1111/jpc.14191

    M3 - Article

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    SP - 305

    EP - 311

    JO - Journal of Paediatrics and Child Health

    JF - Journal of Paediatrics and Child Health

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