Decision support guidelines safely reduce unnecessary testing for very sick children, study finds
Clinicians often collect an endotracheal aspirate culture (EAC) from patients of all ages with breathing tubes to check mucus for signs of bacterial infection, a complication that can be deadly. Historically, however, clinical guidance about when and how often to take such cultures in children has been limited.
Clinical decision support guidelines have been found to safely reduce unnecessary testing for endotracheal aspirate cultures (EAC) in very sick children, according to a new study from Johns Hopkins Children's Center. The research, published in JAMA Network Open, analyzed data from 15 U.S. pediatric ICUs and built upon previous work showing a 40% reduction in culture use without compromising safety.
The study found that when clinicians used algorithms and checklists to consider signs and symptoms of respiratory infection before ordering EAC cultures, the monthly EAC rate across all hospitals decreased by 16%, from 7.80 to 6.55 cultures per 100 ventilator-days. Importantly, this reduction in testing was not associated with any changes in antibiotic prescribing, ventilation duration, hospital stay, or readmissions.
Lead author Anna Sick-Samuels, an infectious disease specialist, explains that the study demonstrates the feasibility of reducing respiratory cultures in patients without signs of lung infections while ensuring patient safety remains intact. The findings support the goal of standardizing culture testing and reducing unnecessary antibiotic use in pediatric intensive care settings.
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