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Variations in the management of pneumonia in pediatric emergency departments: compliance with the guidelines

Published online by Cambridge University Press:  21 May 2015

Aiman Alak ,
Jamie A. Seabrook  and
Michael J. Rieder
Aiman Alak
Affiliation:
Department of Paediatrics, Children's Hospital, London Health Science Centre, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont.
Jamie A. Seabrook
Affiliation:
Departments of Paediatrics and Sociology, Children's Health Research Institute, University of Western Ontario, London, Ont.
Michael J. Rieder*
Affiliation:
Division of Emergency Medicine, Departments of Paediatrics, Medicine, Clinical Pharmacology, Physiology and Pharmacology, Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont.
*
Department of Paediatrics, Schulich School of Medicine, University of Western Ontario, 800 Commissioner’s Rd. E, London ON N6A 4G5, [email protected]

Abstract

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Objective:

We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions.

Methods:

We conducted a chart review at the Children's Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study.

Results:

Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%–66%, n = 211) in children 5–18 years old and 83.0% (95% CI 80%–86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed.

Conclusion:

Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5–18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials.

Keywords

pneumoniachildpediatricsdisease managementphysicians' practice patterns
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 12 , Issue 6 , September 2010 , pp. 514 - 519
Copyright
Copyright © Canadian Association of Emergency Physicians 2010

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