METHODS: Using the Pediatric Health Information Systems database, we studied patients discharged from the hospital with a diagnosis of ALTE/BRUE from January 2012 to December 2019. We grouped encounters into 2 time cohorts on the basis of discharge date: preguideline (January 2012-January 2016) and postguideline (July 2016-December 2019). We used interrupted time series to test if the CPG publication was associated with level change and change in slope for each metric.
RESULTS: The study included 27 941 hospitalizations for ALTE/BRUE from 36 hospitals. There was an early decrease in 12 diagnostic tests that the CPG strongly recommended against. There was a positive change in the use of electrocardiogram (+3.5%, P < .001), which is recommended by CPG. There was a significant reduction in admissions (-13.7%, P < .001), utilization of medications (-8.3%, P < .001), cost (-$1146.8, P < .001), and LOS (-0.2 days, P < .001), without a change in the revisit rates. In the postguideline period, there were an estimated 2678 admissions avoided out of 12 508 encounters.
CONCLUSIONS: Publication of the American Academy of Pediatrics BRUE CPG was associated with substantial reductions in testing, utilization of medications, admission rates, cost, and LOS, without a change in the revisit rates.
方法:使用儿科健康信息系统数据库,我们研究了2012年1月至2019年12月诊断为ALTE/BRUE的出院患者.我们根据出院日期将遇到的问题分为2个时间队列:指南前(2012年1月至2016年1月)和指南后(2016年7月至2019年12月)。我们使用中断的时间序列来测试CPG出版物是否与每个指标的水平变化和斜率变化相关。
结果:该研究包括36家医院的27941例ALTE/BRUE住院治疗。CPG强烈建议反对的12项诊断测试早期减少。心电图的使用有积极变化(+3.5%,P<.001),这是CPG推荐的。入学人数显着减少(-13.7%,P<.001),药物利用率(-8.3%,P<.001),成本(-1146.8美元,P<.001),和LOS(-0.2天,P<.001),没有改变重访率。在引导后期间,在12508次相遇中,估计有2678人避免入院。
结论:美国儿科学会的出版物BRUECPG与检测的大幅减少有关,利用药物,录取率,成本,还有LOS,没有改变重访率。