title: Variations in the management of pneumonia in pediatric emergency departments: compliance with the guidelines.
abstract: OBJECTIVE
  We sought to assess compliance with evidence-based guidelines for the management of pediatric pneumonia, including the variations in tests ordered and antimicrobials prescribed. Our primary hypothesis was that compliance with the treatment recommendations from the most current guidelines would be low for antimicrobial prescriptions.
  
  
  METHODS
  We conducted a chart review at the Children's Hospital in London, Ont., to assess variation in the management of pediatric pneumonia. All patients aged 3 months to 18 years seen at the pediatric emergency department between Apr. 1, 2006, and Mar. 31, 2007, with a diagnosis of pneumonia were eligible for inclusion in the study.
  
  
  RESULTS
  Compliance with management guidelines was 59.7% (95% confidence interval [CI] 53%-66%, n = 211) in children 5-18 years old and 83.0% (95% CI 80%-86%, n = 605) in children 3 months to 5 years old. Significant variation existed in the choice of antimicrobial agent for children with pneumonia, with nonrecommended agents frequently prescribed.
  
  
  CONCLUSIONS
  Significant variation existed in the management of pediatric pneumonia, and adherence to guidelines was low for the group of patients aged 5-18 years. Future studies should attempt to provide guidance to distinguish between viral and bacterial etiology to allow judicious use of antimicrobials.
authors.affiliation: Department of Paediatrics, Children's Hospital, London Health Science Centre, University of Western Ontario, Ontario, Canada.
authors.forename: Aiman
authors.initials: A
authors.lastname: Alak
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Seabrook
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rieder
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D019983:Guideline Adherence; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario; D011014:Pneumonia / Q000628:therapy*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016896:Treatment Outcome