Management of Urinary Tract Infections in Young Children: Balancing Admission With the Risk of Emergency Department Revisits

Pradip P Chaudhari; Michael C Monuteaux; Richard G Bachur

doi:10.1016/j.acap.2018.05.011

Management of Urinary Tract Infections in Young Children: Balancing Admission With the Risk of Emergency Department Revisits

Acad Pediatr. 2019 Mar;19(2):203-208. doi: 10.1016/j.acap.2018.05.011. Epub 2018 Jun 1.

Authors

Pradip P Chaudhari¹, Michael C Monuteaux², Richard G Bachur²

Affiliations

¹ Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, Calif (PP Chaudhari); and Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass (MC Monuteaux and RG Bachur). Electronic address: pchaudhari@chla.usc.edu.
² Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, Calif (PP Chaudhari); and Division of Emergency Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Mass (MC Monuteaux and RG Bachur).

PMID: 29864523
DOI: 10.1016/j.acap.2018.05.011

Abstract

Objective: Oral antibiotics effectively treat most pediatric urinary tract infections (UTIs); however, children with UTIs are frequently admitted. We examined variation and trends in admission for children with UTIs plus investigated the relationship between admission and emergency department (ED) revisits for those initially managed on an outpatient basis. We hypothesized that hospitals would have similar 3-day revisit rates regardless of the admission rate at the index visit.

Methods: This was a retrospective analysis of 36 hospitals in the Pediatric Health Information System. ED visits for children aged <2 years presenting with UTI between 2010 and 2016 were studied. Main outcomes were age-stratified and included admission and 3-day ED revisit rates. Regression analyses were used to test hospital-level associations between outcomes and linear temporal trends.

Results: A total of 41,792 visits were studied. The overall admission rate was 27%. The admission rate was 89% for children aged <2 months and 15% for those aged 2 to 24 months. Interhospital admission rates varied from 6% to 64%. Admission and revisit rates were inversely related (mean change, -0.07; 95% confidence interval [CI], -0.13 to -0.02 per 1% increase in admission rate); however, lower admission rates were not associated with increased revisits leading to admission (mean change, -0.02; 95% CI, -0.07 to 0.03). Over the study period, admission rates were stable (test for linear trend: adjusted odds ratio [aOR], 0.99; 95% CI, 0.95-1.02); however, among infants aged <2 months, admissions decreased (aOR, 0.92; 95% CI, 0.88-0.97).

Conclusions: A substantial variation in admission rates exists for children with UTI. Although hospitals with lower admission rates had higher revisit rates, those hospitals did not have an increase in revisits with subsequent admission, supporting the goal of outpatient management.

Keywords: UTI; emergency department; hospitalization; variation.

MeSH terms

Anti-Bacterial Agents / therapeutic use*
Disease Management
Emergency Service, Hospital / statistics & numerical data*
Female
Hospitalization / statistics & numerical data*
Humans
Infant
Infant, Newborn
Male
Odds Ratio
Patient Readmission / statistics & numerical data*
Pyelonephritis / drug therapy*
Retrospective Studies
Urinary Tract Infections / drug therapy*

Substances

Anti-Bacterial Agents