{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,13]],"date-time":"2026-09-13T18:49:19Z","timestamp":1789325359834,"version":"build-2803163510"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T00:00:00Z","timestamp":1660089600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Current diagnostics do not permit reliable differentiation of bacterial from viral causes of lower respiratory tract infection (LRTI), which may lead to over\u2010treatment with antibiotics for possible bacterial community\u2010acquired pneumonia (CAP).<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We sought to describe variation in the diagnosis and treatment of bacterial CAP among children hospitalized with LRTIs and determine the association between CAP diagnosis and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting and Participants<\/jats:title><jats:p>This multicenter cross\u2010sectional study included children hospitalized between 2017 and 2019 with LRTIs at 42 children's hospitals.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome and Methods<\/jats:title><jats:p>We calculated the proportion of children with LRTIs who were diagnosed with and treated for bacterial CAP. After adjusting for confounders, hospitals were grouped into high, moderate, and low CAP diagnosis groups. Multivariable regression was used to examine the association between high and low CAP diagnosis groups and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We identified 66,581 patients hospitalized with LRTIs and observed substantial variation across hospitals in the proportion diagnosed with and treated for bacterial CAP (median 27%, range 12%\u201342%). Compared with low CAP diagnosing hospitals, high diagnosing hospitals had higher rates of CAP\u2010related revisits (0.6% [95% confidence interval: 0.5, 0.7] vs. 0.4% [0.4, 0.5], <jats:italic>p<\/jats:italic>\u2009=\u2009.04), chest radiographs (58% [53, 62] vs. 46% [41, 51], <jats:italic>p<\/jats:italic>\u2009=\u2009.02), and blood tests (43% [33, 53] vs. 26% [19, 35], <jats:italic>p<\/jats:italic>\u2009=\u2009.046). There were no significant differences in length of stay, all\u2010cause revisits or readmissions, CAP\u2010related readmissions, or costs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There was wide variation across hospitals in the proportion of children with LRTIs who were treated for bacterial CAP. The lack of meaningful differences in clinical outcomes among hospitals suggests that some institutions may over\u2010diagnose and overtreat bacterial CAP.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhm.12940","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T05:43:28Z","timestamp":1660110208000},"page":"872-879","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Variation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7978-9045","authenticated-orcid":false,"given":"Jillian M.","family":"Cotter","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7778-5887","authenticated-orcid":false,"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Children's Hospital Association  Lenexa Kansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7902-7000","authenticated-orcid":false,"given":"Samir S.","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6290-568X","authenticated-orcid":false,"given":"Matthew J.","family":"Molloy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica L.","family":"Markham","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Mercy Kansas City University of Missouri Kansas City  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Departments of Pediatrics and Emergency Medicine Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John R.","family":"Stephens","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of North Carolina School of Medicine  Chapel Hill North Carolina USA"},{"name":"Department of Medicine University of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Steiner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of North Carolina School of Medicine  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elisha","family":"McCoy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Medicine Le Bonheur Children's Hospital, University of Tennessee Health Science Center  Memphis Tennessee USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Collins","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Children's Mercy Kansas City University of Missouri Kansas City  Kansas City Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Tchou","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,8,10]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpediatrics.2012.1266"},{"key":"#cr-split#-e_1_2_7_3_1.1","unstructured":"PfuntnerA WierLM SteinerC.Agency for Healthcare Research and Quality. 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