title: Influence of hospital guidelines on management of children hospitalized with pneumonia.
abstract: OBJECTIVE
  Clinical practice guidelines (CPGs) assist clinicians in making appropriate diagnostic and treatment decisions based on available evidence. The objective of this study was to describe the availability and content of institutional community-acquired pneumonia (CAP) CPGs, and to evaluate the association between institutional CPGs and care utilization, antibiotic administration, and outcomes among children hospitalized with CAP.
  
  
  METHODS
  This multicenter retrospective cohort study included children aged 1 to 18 years hospitalized with CAP from July 1, 2009, to June 30, 2011. CPGs from each institution were reviewed to abstract information regarding diagnostic testing and antimicrobial selection. We compared overall and specific utilization patterns, antimicrobial use, and hospital length of stay (LOS) for children with CAP between hospitals with and without CPGs.
  
  
  RESULTS
  Thirteen (31.7%) of 41 hospitals had an institutional CPG for nonsevere CAP. There was marked heterogeneity among CPGs. Among the 19,710 children hospitalized with CAP, cost of care, hospital LOS, and 14-day readmission rate were not associated with the presence of a CPG. CPGs did not influence ordering patterns for most diagnostic tests, including blood culture and chest radiographs. Penicillin or aminopenicillins were prescribed to 46.3% of children at institutions where a CPG recommended the use of these antibiotics as first-line agents compared with 23.9% of children at institutions without a CPG (odds ratio = 2.7; 95% confidence interval = 1.4-5.5).
  
  
  CONCLUSIONS
  The availability of a CAP CPG had minimal impact on resource utilization and was not associated with cost or hospital LOS. Institutional CPGs, however, did influence patterns of antimicrobial use.
authors.affiliation: Children's Hospital, Division of Emergency Medicine, 300 Longwood Ave, Boston, MA 02115, USA. mark.neuman@childrens.harvard.edu
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Brogan
authors.forename: Kavita
authors.initials: K
authors.lastname: Parikh
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.forename: Anne J
authors.initials: AJ
authors.lastname: Blaschke
authors.forename: Derek J
authors.initials: DJ
authors.lastname: Williams
authors.forename: Carlos G
authors.initials: CG
authors.lastname: Grijalva
authors.forename: Amy
authors.initials: A
authors.lastname: Tyler
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000188:drug therapy*; D005260:Female; D006761:Hospitals; D006801:Humans; D007223:Infant; D008297:Male; D018410:Pneumonia, Bacterial / Q000188:drug therapy*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents