Academic Emergency Medicine, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 9, 2024

Respiratory pathogen testing can establish precise diagnoses in children with respiratory infections. Prior work has suggested that improve clinical decision making some contexts.1, 2 However, is costly and causes discomfort to children. Furthermore, as demonstrated pragmatic prospective trials, rarely impacts regarding the need for additional or antimicrobials treated emergency department (ED).3 Recognizing these tests a cause of medical waste, Choosing Wisely campaign, co-developed 2022 by American Academy Pediatrics Canadian Association Emergency Physicians, recommends against multiplex viral healthy suspected common illness.4 Instead, comprehensive panel considered potentially appropriate high-risk patients scenarios where results will directly impact treatment decisions.4 Following onset COVID-19 pandemic, became more children's hospitals.5, 6 Additionally, pandemic not only sparked clinicians' families' interest but also catalyzed development new panels, many which include pathogens. Changes performance ED are unclear. We therefore sought evaluate changes among presenting Illinois. performed an analysis Illinois COMPdata repository, administrative all-payer database nonfederal hospitals Illinois, using data from 2016 2023. The this study was exempt our institutional review board. Our limited 184 provided continuously during period. (<18 years) discharged without underlying complex chronic condition. focused on discharges since typically have lower acuity practices admitted hospital undergoing procedures vary institution, influencing patterns. exposure interests were tests, panels assessed at least three six These categories used because Current Procedural Terminology (CPT) coding system codes way, CPT determine who tested (Table S1). To upon onset, we evaluated periods: prepandemic (January 1, 2016, March 14, 2020), early (March 15, 2020,7 December 31, 2023), late 1 latter corresponded end surge attributed COVID-19, influenza, syncytial virus.5 interrupted time-series linear mixed-effects model, modeling proportion daily encounters. incorporated random intercepts sine cosine terms account known seasonal fluctuations performance. Results expressed between time periods including immediate change transition slope periods. presented absolute (instead relative changes) calculating contrast-weighted sum coefficients capture combined interest. transitions may be understood baseline rate. percent per month. following subgroup analyses. First, infections (defined based presence relevant International Classification Disease, 10th revision, primary secondary position). Second, <2 years age. Third, race ethnicity (recategorized authors classifications within White non-Hispanic, Black Hispanic/Latino). included 6,577,995 encounters over period (median age [IQR 2–12 years]; 51.6% males). Overall, test ordered 7.6% encounters, 2.6% Considering 1.8%, 14.0%, 22.1% prepandemic, early, periods, respectively, had (Figure 1). When considering 0.8%, 4.7%, 5.8% respective testing. Categorized ethnicity, 40.7% non-Hispanic patients, 25.7% 23.6% Hispanic/Latino patients. evaluating utilization model modest positive phase (0.1% month, 95% confidence interval [CI] 0.1% 0.1%). there negative (−7.3%, CI −7.4 −7.3) increase (absolute 0.9% 0.9%). During again (−8.8%, −8.9 −8.6), though remained 0.6% 0.5% 0.6%; Table S2). 0.2% 0.2%), attenuated In analyses, findings similar models (n = 1,390,057; 21.1%) 1,417,730; 21.5%) pathogens derived overall sample. groupings, minor differences, greater shift higher slopes all large use identified having performed. By statewide sample generalizable care children, minority (~5%) obtain freestanding hospitals.8 rationale observed likely multifactorial. reason requirement document infection status school childcare attendance due control measures pandemic. note rise sustained into when requirements decreased nationally. Other explain parent expectations validate perceived clinicians demonstrate action being taken address patient's issue.9 decrease reflects shifts prevalence toward surge. This did occur abrupt pattern statistical represent gradual nature binary way defining pre post role national campaigns, such Wisely, serves important starting point reduce Deimplementation efforts help unnecessary testing, targeted approaches encompass education, partner engagement, audit, feedback.10 support systems facilitate reductions low-value interventions steering evidence-based practices. systematic organizational factors contributing care, enhanced leadership support; empowering physicians; building infrastructure data, technology, staff; data-driven methods track quality; integrating deimplementation goals payment pathways.11 subject limitations. potential inaccuracies data. unable assess indications appropriateness series analysis, deployed here, quasi-experimental nature, meaning it cannot causal relationship diagnosis codes, applied accurately reflect specific disease conditions. Finally, inclusion sets limitations, particularly do always self-identified ethnicity. Despite provide information postpandemic era. conclusion, significant rates peaking 2022. Public awareness efforts, coupled required better align guidelines. Dr. Ramgopal contributed conceptualization, interpretation findings, drafting manuscript. Michelson assisted drafting, critically reviewed revised manuscript intellectual content. Both approved final submitted agree accountable aspects work. SR supported National Institutes Health/National Heart, Lung, Blood Institute (K01HL169921). no conflicts disclose. available request corresponding author. publicly privacy ethical restrictions. Figure S1. subgroups Dashed lines indicate 2020) 2023) predicted line demonstrates modeled generalized mixed accounting related counterfactual depicts NH, Non-Hispanic. Common revision (ICD-10) outcome identification analysis. S2. Findings Numbers parentheses intervals receiving Please note: publisher responsible content functionality any supporting supplied authors. 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Language: Английский