Impact of chest radiography for children with lower respiratory tract infection: a propensity score approach.
BACKGROUND
Management of acute respiratory tract infection varies substantially despite this being a condition frequently encountered in pediatric emergency departments. Previous studies have suggested that the use of antibiotics was higher when chest radiography was performed. However none of these analyses had considered the inherent indication bias of observational studies.


OBJECTIVE
The aim of this work was to assess the relationship between performing chest radiography and prescribing antibiotics using a propensity score analysis to address the indication bias due to non-random radiography assignment.


METHODS
We conducted a prospective study of 697 children younger than 2 years of age who presented during the winter months of 2006-2007 for suspicion of respiratory tract infection at the Pediatric Emergency Department of an urban general hospital in France (Paris suburb). We first determined the individual propensity score (probability of having a chest radiography according to baseline characteristics). Then we assessed the relation between radiography and antibiotic prescription using two methods: adjustment and matching on the propensity score.


RESULTS
We found that performing a chest radiography lead to more frequent antibiotic prescription that may be expressed as OR = 2.3, CI [1.3-4.1], or as an increased use of antibiotics of 18.6% [0.08-0.29] in the group undergoing chest radiography.


CONCLUSIONS
Chest radiography has a significant impact on the management of infants admitted for suspicion of respiratory tract infection in a pediatric emergency department and may lead to unnecessary administration of antibiotics.
Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Le Kremlin Bicêtre, France.
Emmanuelle
E
Ecochard-Dugelay
APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France.
Muriel
M
Beliah
APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France.
Caroline
C
Boisson
APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France.
Francis
F
Perreaux
APHP, Radiology Department, Hopital Antoine Béclère, Clamart, France.
Jocelyne
J
de Laveaucoupet
APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France; Université Paris Sud 11, Kremlin Bicêtre, France.
Philippe
P
Labrune
APHP, Paediatric Department, Centre Hospitalier Intercommunal, Créteil, France; Université Paris Est, Créteil, Val de Marne, France.
Ralph
R
Epaud
APHP, Paediatric Radiology Department, Hôpital Trousseau, Paris, France; Université Paris 6, Paris, France.
Hubert
H
Ducou-Lepointe
Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Le Kremlin Bicêtre, France; Université Paris Sud 11, Kremlin Bicêtre, France.
Jean
J
Bouyer
Inserm, CESP Centre for research in Epidemiology and Population Health, U1018, Reproduction and Child Development Team, Le Kremlin Bicêtre, France; APHP, Paediatric Department, Hopital Antoine Béclère, Clamart, France; Université Paris Sud 11, Kremlin Bicêtre, France.
Vincent
V
Gajdos
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D006786:Hospitals, Urban / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D057216:Propensity Score; D011446:Prospective Studies; D013902:Radiography, Thoracic / Q000379:methods*; D015203:Reproducibility of Results; D012137:Respiratory System / Q000000981:diagnostic imaging* / Q000187:drug effects / Q000503:physiopathology; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy; D012680:Sensitivity and Specificity
D000900:Anti-Bacterial Agents