Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital
Introduction Evidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2022-11-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/11/e062360.full |
| _version_ | 1797984225267286016 |
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| author | Lehana Thabane Marek Smieja Mark Loeb Jeffrey M Pernica Dominik Mertz April J Kam David M Goldfarb Jacqueline Wong Sarah Khan Fiona Smaill Melani Sung Mohamed Eltorki Joycelyne Ewusie |
| author_facet | Lehana Thabane Marek Smieja Mark Loeb Jeffrey M Pernica Dominik Mertz April J Kam David M Goldfarb Jacqueline Wong Sarah Khan Fiona Smaill Melani Sung Mohamed Eltorki Joycelyne Ewusie |
| author_sort | Lehana Thabane |
| collection | DOAJ |
| description | Introduction Evidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there are no clinical criteria that reliably discriminate between viral and bacterial disease, and so the majority of children diagnosed with CAP are given antibiotics—even though these will often not help and may cause harm. We have developed a novel care pathway that incorporates point-of-care biomarkers, radiographic patterns, microbiological testing and targeted follow-up. The primary study objective is to determine if the care pathway will be associated with less antimicrobial prescribing.Methods and analysis A prospective, before–after, study. Previously well children aged≥6 months presenting to a paediatric emergency department (ED) that have at least one respiratory symptom/sign, receive chest radiography, and are diagnosed with CAP by the ED physician will be eligible. Those with medical comorbidities, recently diagnosed pulmonary infection, or ongoing fever after≥4 days of antimicrobial therapy will be excluded. In the control (before) phase, eligible participants will be managed as per the standard of care. In the intervention (after) phase, eligible participants will be managed as per the novel care pathway. The primary outcome will be the proportion of participants in each phase who receive antimicrobial treatment for CAP. The secondary outcomes include: clinical cure; re-presentation to the ED; hospitalisation; time to resolution of symptoms; drug adverse events; caregiver satisfaction; child absenteeism from daycare/school; and caregiver absenteeism from work.Ethics and dissemination All study documentation has been approved by the Hamilton Integrated Research Ethics Board and informed consent will be obtained from all participants. Data from this study will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration number NCT05114161. |
| first_indexed | 2024-04-11T06:58:12Z |
| format | Article |
| id | doaj.art-bae0c12f6da44009ac55c3be0cff7cc5 |
| institution | Directory Open Access Journal |
| issn | 2044-6055 |
| language | English |
| last_indexed | 2024-04-11T06:58:12Z |
| publishDate | 2022-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj.art-bae0c12f6da44009ac55c3be0cff7cc52022-12-22T04:38:56ZengBMJ Publishing GroupBMJ Open2044-60552022-11-01121110.1136/bmjopen-2022-062360Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospitalLehana Thabane0Marek Smieja1Mark Loeb2Jeffrey M Pernica3Dominik Mertz4April J Kam5David M Goldfarb6Jacqueline Wong7Sarah Khan8Fiona Smaill9Melani Sung10Mohamed Eltorki11Joycelyne Ewusie12Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, CanadaDepartment of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canadamethodologist, infectious disease physicianDepartment of Pediatrics, McMaster University, Hamilton, Ontario, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, CanadaPaediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, CanadaHealthy Starts, British Columbia Children’s Hospital Research Institute, Vancouver, British Columbia, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, CanadaCentral Manchester Foundation Trust, Manchester, UKassociate professorMedicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, CanadaMcMaster Children`s Hospital, Hamilton, Ontario, CanadaDepartment of Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, CanadaIntroduction Evidence-based recommendations for paediatric community-acquired pneumonia (CAP) diagnosis and management are needed. Uncomplicated CAP is often caused by respiratory viruses, especially in younger children; these episodes self-resolve without antibiotic treatment. Unfortunately, there are no clinical criteria that reliably discriminate between viral and bacterial disease, and so the majority of children diagnosed with CAP are given antibiotics—even though these will often not help and may cause harm. We have developed a novel care pathway that incorporates point-of-care biomarkers, radiographic patterns, microbiological testing and targeted follow-up. The primary study objective is to determine if the care pathway will be associated with less antimicrobial prescribing.Methods and analysis A prospective, before–after, study. Previously well children aged≥6 months presenting to a paediatric emergency department (ED) that have at least one respiratory symptom/sign, receive chest radiography, and are diagnosed with CAP by the ED physician will be eligible. Those with medical comorbidities, recently diagnosed pulmonary infection, or ongoing fever after≥4 days of antimicrobial therapy will be excluded. In the control (before) phase, eligible participants will be managed as per the standard of care. In the intervention (after) phase, eligible participants will be managed as per the novel care pathway. The primary outcome will be the proportion of participants in each phase who receive antimicrobial treatment for CAP. The secondary outcomes include: clinical cure; re-presentation to the ED; hospitalisation; time to resolution of symptoms; drug adverse events; caregiver satisfaction; child absenteeism from daycare/school; and caregiver absenteeism from work.Ethics and dissemination All study documentation has been approved by the Hamilton Integrated Research Ethics Board and informed consent will be obtained from all participants. Data from this study will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.Trial registration number NCT05114161.https://bmjopen.bmj.com/content/12/11/e062360.full |
| spellingShingle | Lehana Thabane Marek Smieja Mark Loeb Jeffrey M Pernica Dominik Mertz April J Kam David M Goldfarb Jacqueline Wong Sarah Khan Fiona Smaill Melani Sung Mohamed Eltorki Joycelyne Ewusie Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital BMJ Open |
| title | Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital |
| title_full | Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital |
| title_fullStr | Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital |
| title_full_unstemmed | Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital |
| title_short | Novel care pathway to optimise antimicrobial prescribing for uncomplicated community-acquired pneumonia: study protocol for a prospective before–after cohort study in the emergency department of a tertiary care Canadian children’s hospital |
| title_sort | novel care pathway to optimise antimicrobial prescribing for uncomplicated community acquired pneumonia study protocol for a prospective before after cohort study in the emergency department of a tertiary care canadian children s hospital |
| url | https://bmjopen.bmj.com/content/12/11/e062360.full |
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