{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,16]],"date-time":"2025-10-16T20:34:48Z","timestamp":1760646888838,"version":"3.40.5"},"reference-count":40,"publisher":"American Academy of Pediatrics (AAP)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,9,1]]},"abstract":"<jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>The incidence of staphylococcal scalded skin syndrome (SSSS) is rising, but current practice variation in diagnostic test use is not well described. Our aim was to describe the variation in diagnostic test use in children hospitalized with SSSS and to determine associations with patient outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>We performed a retrospective (2011\u20132016) cohort study of children aged 0 to 18 years from 35 children\u2019s hospitals in the Pediatric Health Information System database. Tests included blood culture, complete blood count, erythrocyte sedimentation rate, C-reactive protein level, serum chemistries, and group A streptococcal testing. K-means clustering was used to stratify hospitals into groups of high (cluster 1) and low (cluster 2) test use. Associations between clusters and patient outcomes (length of stay, cost, readmissions, and emergency department revisits) were assessed with generalized linear mixed-effects modeling.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>We included 1259 hospitalized children with SSSS; 84% were \u22644 years old. Substantial interhospital variation was seen in diagnostic testing. Blood culture was the most commonly obtained test (range 62%\u2013100%), with the most variation seen in inflammatory markers (14%\u2013100%). Between hospital clusters 1 and 2, respectively, there was no significant difference in adjusted length of stay (2.6 vs 2.5 days; P = .235), cost ($4752 vs $4453; P = .591), same-cause 7-day readmission rate (0.8% vs 0.4%; P = .349), or emergency department revisit rates (0.1% vs 0.6%; P = .148).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>For children hospitalized with SSSS, lower use of diagnostic tests was not associated with changes in outcomes. Hospitals with high diagnostic test use may be able to reduce testing without adversely affecting patient outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1542\/hpeds.2018-0032","type":"journal-article","created":{"date-parts":[[2018,8,31]],"date-time":"2018-08-31T08:29:34Z","timestamp":1535704174000},"page":"530-537","source":"Crossref","is-referenced-by-count":9,"title":["Variation in Diagnostic Test Use and Associated Outcomes in Staphylococcal Scalded Skin Syndrome at Children\u2019s Hospitals"],"prefix":"10.1542","volume":"8","author":[{"given":"Hannah C.","family":"Neubauer","sequence":"first","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matt","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Children\u2019s Hospital Association, Lenexa, Kansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sowdhamini S.","family":"Wallace","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrea T.","family":"Cruz","sequence":"additional","affiliation":[{"name":"Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary Ann","family":"Queen","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children\u2019s Mercy Kansas City, Kansas City, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dana M.","family":"Foradori","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul L.","family":"Aronson","sequence":"additional","affiliation":[{"name":"Section of Pediatric Emergency Medicine, Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jessica L.","family":"Markham","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children\u2019s Mercy Kansas City, Kansas City, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer A.","family":"Nead","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Upstate Golisano Children\u2019s Hospital, Syracuse, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabrielle Z.","family":"Hester","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, Children\u2019s Minnesota, Minneapolis, Minnesota"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Russell J.","family":"McCulloh","sequence":"additional","affiliation":[{"name":"Divisions of Pediatric Hospital Medicine and Infectious Diseases, Children\u2019s Mercy Kansas City, Kansas City, Missouri;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle A.","family":"Lopez","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hospital Medicine, Department of Pediatrics, Texas Children\u2019s Hospital and Baylor College of Medicine, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2018,9,1]]},"reference":[{"issue":"12","key":"2021120817312586800_B1","doi-asserted-by":"crossref","first-page":"E514","DOI":"10.1111\/1469-0691.12053","article-title":"Epidemiological data of staphylococcal scalded skin syndrome in France from 1997 to 2007 and microbiological characteristics of Staphylococcus aureus associated strains","volume":"18","author":"Lamand","year":"2012","journal-title":"Clin Microbiol Infect"},{"key":"2021120817312586800_B2","first-page":"671","article-title":"Increasing numbers of staphylococcal scalded skin syndrome cases at Texas Children\u2019s Hospital are caused by ST121","volume-title":"Open Forum Infect Dis","author":"Hulten","year":"2016"},{"issue":"4","key":"2021120817312586800_B3","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1097\/01.inf.0000060826.85530.fb","article-title":"Neonatal staphylococcal skin infections","volume":"22","author":"Faden","year":"2003","journal-title":"Pediatr Infect Dis J"},{"issue":"1","key":"2021120817312586800_B4","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1111\/pde.12114","article-title":"Staphylococcal scalded skin syndrome in neonates: an 8-year retrospective study in a single institution","volume":"31","author":"Li","year":"2014","journal-title":"Pediatr Dermatol"},{"issue":"5","key":"2021120817312586800_B5","doi-asserted-by":"crossref","first-page":"720","DOI":"10.3201\/eid1405.070153","article-title":"Increasing hospitalizations and general practice prescriptions for community-onset staphylococcal disease, England","volume":"14","author":"Hayward","year":"2008","journal-title":"Emerg Infect Dis"},{"issue":"3","key":"2021120817312586800_B6","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1111\/bjd.16097","article-title":"Epidemiology of staphylococcal scalded skin syndrome in U.S. children","volume":"178","author":"Staiman","year":"2018","journal-title":"Br J Dermatol"},{"issue":"1","key":"2021120817312586800_B7","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.burns.2007.02.006","article-title":"Severe staphylococcal scalded skin syndrome in children","volume":"34","author":"Blyth","year":"2008","journal-title":"Burns"},{"issue":"1","key":"2021120817312586800_B8","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1111\/j.1365-2133.2011.10515.x","article-title":"Mild staphylococcal scalded skin syndrome: an underdiagnosed clinical disorder","volume":"166","author":"Hubiche","year":"2012","journal-title":"Br J Dermatol"},{"issue":"7","key":"2021120817312586800_B9","doi-asserted-by":"crossref","first-page":"727","DOI":"10.1097\/INF.0b013e31828e89f5","article-title":"Skin findings of Staphylococcus aureus toxin-mediated infection in relation to toxin encoding genes","volume":"32","author":"Courjon","year":"2013","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"2021120817312586800_B10","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1128\/CMR.12.2.224","article-title":"Clinical, microbial, and biochemical aspects of the exfoliative toxins causing staphylococcal scalded-skin syndrome","volume":"12","author":"Ladhani","year":"1999","journal-title":"Clin Microbiol Rev"},{"key":"2021120817312586800_B11","unstructured":"Healthcare Cost and Utilization Project.Overview of the kids\u2019 inpatient database (KID). Available at: www.hcup-us.ahrq.gov\/kidoverview.jsp. Accessed October 16, 2017"},{"issue":"8","key":"2021120817312586800_B12","doi-asserted-by":"crossref","first-page":"2529","DOI":"10.1128\/JCM.00406-17","article-title":"Emergence of a Staphylococcus aureus clone resistant to mupirocin and fusidic acid carrying exotoxin genes and causing mainly skin infections","volume":"55","author":"Doudoulakakis","year":"2017","journal-title":"J Clin Microbiol"},{"issue":"12","key":"2021120817312586800_B13","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1007\/s00431-010-1252-1","article-title":"Neonatal staphylococcal scalded skin syndrome: clinical and outbreak containment review","volume":"169","author":"Neylon","year":"2010","journal-title":"Eur J Pediatr"},{"issue":"1","key":"2021120817312586800_B14","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S0163-4453(88)96249-4","article-title":"Outbreak of staphylococcal scalded skin syndrome among neonates","volume":"16","author":"Dancer","year":"1988","journal-title":"J Infect"},{"issue":"9","key":"2021120817312586800_B15","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1097\/00006454-200009000-00002","article-title":"Difficulties in diagnosis and management of the staphylococcal scalded skin syndrome","volume":"19","author":"Ladhani","year":"2000","journal-title":"Pediatr Infect Dis J"},{"issue":"2","key":"2021120817312586800_B16","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1086\/498901","article-title":"A clinical and microbiological comparison of Staphylococcus aureus toxic shock and scalded skin syndromes in children","volume":"42","author":"Chi","year":"2006","journal-title":"Clin Infect Dis"},{"issue":"4","key":"2021120817312586800_B17","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1007\/s00431-014-2414-3","article-title":"Exfoliative toxin A staphylococcal scalded skin syndrome in preterm infants","volume":"174","author":"Saida","year":"2015","journal-title":"Eur J Pediatr"},{"issue":"4","key":"2021120817312586800_B18","doi-asserted-by":"crossref","first-page":"1890","DOI":"10.1128\/JCM.43.4.1890-1893.2005","article-title":"Clinical manifestations of staphylococcal scalded-skin syndrome depend on serotypes of exfoliative toxins","volume":"43","author":"Yamasaki","year":"2005","journal-title":"J Clin Microbiol"},{"issue":"6","key":"2021120817312586800_B19","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1046\/j.1198-743x.2001.00258.x","article-title":"Recent developments in staphylococcal scalded skin syndrome","volume":"7","author":"Ladhani","year":"2001","journal-title":"Clin Microbiol Infect"},{"issue":"1","key":"2021120817312586800_B20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jaad.2015.06.033","article-title":"Skin biopsy: biopsy issues in specific diseases","volume":"74","author":"Elston","year":"2016","journal-title":"J Am Acad Dermatol"},{"issue":"11","key":"2021120817312586800_B21","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1111\/jdv.12541","article-title":"Staphylococcal scalded skin syndrome: diagnosis and management in children and adults","volume":"28","author":"Handler","year":"2014","journal-title":"J Eur Acad Dermatol Venereol"},{"issue":"14","key":"2021120817312586800_B22","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1001\/jama.2012.362","article-title":"Eliminating waste in US health care","volume":"307","author":"Berwick","year":"2012","journal-title":"JAMA"},{"issue":"11","key":"2021120817312586800_B23","doi-asserted-by":"crossref","first-page":"e78962","DOI":"10.1371\/journal.pone.0078962","article-title":"The landscape of inappropriate laboratory testing: a 15-year meta-analysis","volume":"8","author":"Zhi","year":"2013","journal-title":"PLoS One"},{"issue":"4","key":"2021120817312586800_B24","doi-asserted-by":"crossref","first-page":"82","DOI":"10.21037\/atm.2017.02.04","article-title":"Inappropriateness in laboratory medicine: an elephant in the room?","volume":"5","author":"Lippi","year":"2017","journal-title":"Ann Transl Med"},{"issue":"3","key":"2021120817312586800_B25","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1128\/JCM.02264-16","article-title":"Implementation of rapid molecular infectious disease diagnostics: the role of diagnostic and antimicrobial stewardship","volume":"55","author":"Messacar","year":"2017","journal-title":"J Clin Microbiol"},{"issue":"7","key":"2021120817312586800_B26","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1001\/jama.2017.8531","article-title":"Diagnostic stewardship-leveraging the laboratory to improve antimicrobial use","volume":"318","author":"Morgan","year":"2017","journal-title":"JAMA"},{"issue":"17","key":"2021120817312586800_B27","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1001\/jama.299.17.2048","article-title":"Corticosteroids and mortality in children with bacterial meningitis","volume":"299","author":"Mongelluzzo","year":"2008","journal-title":"JAMA"},{"key":"2021120817312586800_B28","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1186\/1471-2431-14-199","article-title":"Pediatric complex chronic conditions classification system version 2: updated for ICD-10 and complex medical technology dependence and transplantation","volume":"14","author":"Feudtner","year":"2014","journal-title":"BMC Pediatr"},{"issue":"4","key":"2021120817312586800_B29","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1542\/peds.2004-0650","article-title":"Clinical redesign using all patient refined diagnosis related groups","volume":"114","author":"Sedman","year":"2004","journal-title":"Pediatrics"},{"issue":"4","key":"2021120817312586800_B30","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1542\/peds.2014-1382","article-title":"Variation in care of the febrile young infant &lt;90 days in US pediatric emergency departments","volume":"134","author":"Aronson","year":"2014","journal-title":"Pediatrics"},{"key":"2021120817312586800_B31","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.jpeds.2016.07.024","article-title":"Diagnostic testing and hospital outcomes of children with neurologic impairment and bacterial pneumonia","volume":"178","author":"Thomson","year":"2016","journal-title":"J Pediatr"},{"issue":"10","key":"2021120817312586800_B32","doi-asserted-by":"crossref","first-page":"627","DOI":"10.3928\/00904481-20100922-02","article-title":"MRSA, staphylococcal scalded skin syndrome, and other cutaneous bacterial emergencies","volume":"39","author":"Berk","year":"2010","journal-title":"Pediatr Ann"},{"issue":"3","key":"2021120817312586800_B33","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1542\/peds.2013-1384","article-title":"Blood cultures in the evaluation of uncomplicated skin and soft tissue infections","volume":"132","author":"Malone","year":"2013","journal-title":"Pediatrics"},{"issue":"2","key":"2021120817312586800_B34","doi-asserted-by":"crossref","first-page":"e10","DOI":"10.1093\/cid\/ciu296","article-title":"Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America [published correction appears in Clin Infect Dis. 2015;60(9):1448]","volume":"59","author":"Stevens","year":"2014","journal-title":"Clin Infect Dis"},{"issue":"11","key":"2021120817312586800_B35","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1111\/1346-8138.12638","article-title":"Value of serum procalcitonin and interleukin-6 in patients with bullous impetigo and staphylococcal scalded skin syndrome","volume":"41","author":"Zeng","year":"2014","journal-title":"J Dermatol"},{"issue":"1","key":"2021120817312586800_B36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1542\/hpeds.2015-0099","article-title":"Toward high-value care: a quality improvement initiative to reduce unnecessary repeat complete blood counts and basic metabolic panels on a pediatric hospitalist service","volume":"6","author":"Johnson","year":"2016","journal-title":"Hosp Pediatr"},{"issue":"3","key":"2021120817312586800_B37","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1111\/pde.12195","article-title":"Antibiotic sensitivity and resistance patterns in pediatric staphylococcal scalded skin syndrome","volume":"31","author":"Braunstein","year":"2014","journal-title":"Pediatr Dermatol"},{"issue":"2","key":"2021120817312586800_B38","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1016\/j.burns.2011.08.005","article-title":"Staphylococcal scalded skin syndrome in the Czech Republic: an epidemiological study","volume":"38","author":"Lipov\u00fd","year":"2012","journal-title":"Burns"},{"issue":"2","key":"2021120817312586800_B39","doi-asserted-by":"crossref","first-page":"e134","DOI":"10.1055\/s-0037-1603971","article-title":"Recurrent staphylococcal scalded skin syndrome in an extremely low-birth-weight neonate","volume":"7","author":"Davidson","year":"2017","journal-title":"AJP Rep"},{"issue":"26","key":"2021120817312586800_B40","doi-asserted-by":"crossref","first-page":"e48","DOI":"10.1056\/NEJMp1111662","article-title":"The savings illusion\u2013why clinical quality improvement fails to deliver bottom-line results","volume":"365","author":"Rauh","year":"2011","journal-title":"N Engl J Med"}],"container-title":["Hospital Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/8\/9\/530\/815223\/hpeds_2018-0032.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article-pdf\/8\/9\/530\/815223\/hpeds_2018-0032.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T20:16:55Z","timestamp":1720556215000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/hospitalpediatrics\/article\/8\/9\/530\/26651\/Variation-in-Diagnostic-Test-Use-and-Associated"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,1]]},"references-count":40,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2018,9,1]]},"published-print":{"date-parts":[[2018,9,1]]}},"URL":"https:\/\/doi.org\/10.1542\/hpeds.2018-0032","relation":{},"ISSN":["2154-1663","2154-1671"],"issn-type":[{"type":"print","value":"2154-1663"},{"type":"electronic","value":"2154-1671"}],"subject":[],"published":{"date-parts":[[2018,9,1]]}}}