title: Diagnostic Testing and Hospital Outcomes of Children with Neurologic Impairment and Bacterial Pneumonia.
abstract: OBJECTIVE
  To assess hospital-level variability in diagnostic testing and outcomes for children with neurologic impairment hospitalized with pneumonia.
  
  
  METHODS
  A retrospective cohort study of 27 455 children ages 1-18 years with neurologic impairment hospitalized with pneumonia at 39 children's hospitals. K-means clustering was used to assign each hospital to 1 of 3 groups (termed A, B, and C) based on similar diagnostic testing patterns. Outcomes of hospital-level median length of stay (LOS), 30-day readmissions, and pneumonia-associated complications were compared while controlling for patient differences.
  
  
  RESULTS
  Overall, 48.5% had comorbid complex chronic conditions, and 25.4% were assisted with medical technology. Outcomes and diagnostic testing varied across hospitals: median hospital-level LOS, 3.2 days (IQR 2.8-3.8); median readmission, 8.4% (IQR 6.8,-10.0); and median pneumonia-associated complication rate, 23.1% (IQR 18.7-26.8). Despite similar populations, hospitals in group A tended to perform fewer tests than those in groups B and C. Across hospital groups, there was a significant difference in adjusted readmission rates (group A 7.2%, group B 9.0%, group C 7.7%, P = .003). There was no significant difference in adjusted median LOS (group A 3.4 days, group B 3.2 days, group C 3.3 days, P = .3) or adjusted pneumonia-associated complication rates (group A 22.5%, group B 22.5%, group C 25.0%, P = .6).
  
  
  CONCLUSIONS
  For children with neurologic impairment hospitalized with pneumonia, across hospital differences in diagnostic testing were not associated with clinically meaningful differences in outcomes. High-utilizing hospitals may be able to decrease diagnostic testing for children with neurologic impairment hospitalized with pneumonia without adversely impacting outcomes.
authors: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: joanna.thomson@cchmc.org.
authors: Joanna
authors: J
authors: Thomson
authors: Children's Hospital Association, Overland Park, KS.
authors: Matt
authors: M
authors: Hall
authors: Division of General Pediatrics, Children's Hospital Boston, Boston, MA; Department of Pediatrics, Harvard Medical School, Boston, MA.
authors: Jay G
authors: JG
authors: Berry
authors: Division of Inpatient Medicine, Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, UT; Department of Pediatrics, University of Utah, Salt Lake City, UT.
authors: Bryan
authors: B
authors: Stone
authors: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Lilliam
authors: L
authors: Ambroggio
authors: Division of Inpatient Medicine, Primary Children's Medical Center, Intermountain Health Care, Salt Lake City, UT; Institute for Healthcare Delivery Research, Intermountain Healthcare, Salt Lake City, UT.
authors: Rajendu
authors: R
authors: Srivastava
authors: Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors: Samir S
authors: SS
authors: Shah
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018410:Pneumonia, Bacterial / Q000150:complications*; D012189:Retrospective Studies
keywords: children with neurologic impairment; pneumonia; variation