Project Summary. We propose to evaluate the impact of antibiotic prescribing patterns on hospital revisit rates among children with community acquired pneumonia.

1) Among children discharged from emergency department (ED) with Community Acquired Pneumonia (CAP), does antibiotic prescribing patterns impact 3-day and 7-day revisit rates? 

Hypothesis 1: Children receiving amoxicillin do not have higher ED revisit rates compared to children receiving a cephalosporin antibiotic. 

Hypothesis 2: School age children who receive a macrolide antibiotic (e.g. azithromycin) in combination with amoxicillin are less likely to have an ED revisit compared with children receiving amoxicillin alone.  

2) Among children hospitalized with CAP, does antibiotic prescribing patterns impact 30-day readmission rates?

Hypothesis 3: Hospitalized children who receive amoxicillin after discharge are less likely to be readmitted within 30-days following discharge compared to children receiving a cephalosporin antibiotic.

Study Design. We propose a retrospective cohort study of children cared for at 8 children’s hospitals included in the PEDSnet database with CAP.

Engagement. This proposal will evaluate the impact of antibiotic use on ED revisit rates among children discharged from the Emergency Department with community-acquired pneumonia (CAP). This initial information will help to evaluate the effectiveness of narrow versus broad-spectrum antibiotic use, which will provide the foundation for shared-decision making between providers and patients around antibiotic use for pediatric pneumonia.

Data Elements. We will define pneumonia using a previously validated set of International Classification of Diseases, 9th Revision (ICD-9) discharge diagnosis codes: 1) Primary diagnosis of pneumonia (481-483.8, 485-486); or 2) Primary diagnosis of pleural effusion (510.0, 510.9, 511.0, 511.1, and 511.9) and a secondary diagnosis of pneumonia. This definition had a sensitivity of approximately 72% and a specificity of 91% for provider-confirmed community-acquired pneumonia.