Variation in Early Inflammatory Marker Testing for Infection-Related Hospitalizations in Children.

Creator(s)

Jessica L. Markham, Children's Mercy HospitalFollow
Cary W. Thurm
Matt Hall, Children's Mercy Hospital
Samir S. Shah
Ricardo Quinonez
Michael J. Tchou
James W. Antoon
Marquita C. Genies
Raymond Parlar-Chun
David P. Johnson
Snehal P. Shah
Molli Ittel, Children's Mercy HospitalFollow
Patrick W. Brady

Document Type

Article

Publication Date

10-2020

Identifier

DOI: 10.1542/hpeds.2020-0114

Abstract

BACKGROUND AND OBJECTIVES: Inflammatory marker testing in children has been identified as a potential area of overuse. We sought to describe variation in early inflammatory marker (C-reactive protein and erythrocyte sedimentation rate) testing for infection-related hospitalizations across children's hospitals and to determine its association with length of stay (LOS), 30-day readmission rate, and cost.

METHODS: We conducted a cross-sectional study of children aged 0 to 17 years with infection-related hospitalizations using the Pediatric Health Information System. After adjusting for patient characteristics, we examined rates of inflammatory marker testing (C-reactive protein or erythrocyte sedimentation rate) during the first 2 days of hospitalization. We used k-means clustering to assign each hospital to 1 of 3 groups on the basis of similarities in adjusted diagnostic testing rates across 12 infectious conditions. Multivariable regression was used to examine the association between hospital testing group and outcomes.

RESULTS: We included 55 771 hospitalizations from 48 hospitals. In 7945 (14.3%), there was inflammatory marker testing in the first 2 days of hospitalization. We observed wide variation in inflammatory marker testing rates across hospitals and infections. Group A hospitals tended to perform more tests than group B or C hospitals (37.4% vs 18.0% vs 10.4%; P < .001) and had the longest adjusted LOS (3.2 vs 2.9 vs 2.8 days; P = .01). There was no significant difference in adjusted 30-day readmission rates or costs.

CONCLUSIONS: Inflammatory marker testing varied widely across hospitals. Hospitals with higher inflammatory testing for one infection tend to test more frequently for other infections and have longer LOS, suggesting opportunities for diagnostic stewardship.

Journal Title

Hosp Pediatr

Volume

10

Issue

10

First Page

851

Last Page

858

Recommended Citation

Markham JL, Thurm CW, Hall M, et al. Variation in Early Inflammatory Marker Testing for Infection-Related Hospitalizations in Children. Hosp Pediatr. 2020;10(10):851-858. doi:10.1542/hpeds.2020-0114