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Assessing Quality Indicators for Pediatric Community-Acquired Pneumonia

Division of Infectious Diseases, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, thomas.sandora{at}childrens.harvard.edu

Rishi Desai, MD

Division of Infectious Disease, Children's Hospital Los Angeles, Los Angeles, California

Benjamin A. Miko, MD

Department of Medicine, New York Presbyterian Hospital, College of Physicians and Surgeons, Columbia University, New York

Marvin B. Harper, MD

Divisions of Infectious Diseases and Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts

To assess applicability of adult quality indicators in the management of pediatric community-acquired pneumonia (CAP), a retrospective cohort study of children admitted with CAP was conducted. The primary outcome was achievement of recommended adult quality indicators. Associations between quality indicators and clinical outcomes were assessed. Most children had rapid oxygenation assessment (97%) and blood culture before antibiotics (98%). Antibiotic timing and selection indicators were met less frequently. The only quality indicator associated with time to stability or length of stay was antibiotic timing; each additional hour until antibiotic administration was associated with a 3% increase in time to clinical stability (P = .001) and a 3% increase in length of stay (P = .002). Recommended adult quality indicators are not achieved by many children with CAP. Time to antibiotic administration is predictive of more rapid stabilization and reduced length of stay. Modification of several other adult measures would improve their applicability for pediatric CAP.

Key Words: quality • pneumonia • children

This version was published on September 1, 2009

American Journal of Medical Quality, Vol. 24, No. 5, 419-427 (2009)
DOI: 10.1177/1062860609337900


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