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American Academy of Pediatrics
Research Articles

Do We Need This Blood Culture?

Kavita Parikh, Aisha Barber Davis and Padmaja Pavuluri
Hospital Pediatrics March 2014, 4 (2) 78-84; DOI: https://doi.org/10.1542/hpeds.2013-0053
Kavita Parikh
Division of Hospitalist Medicine, Children’s National Medical Center and The George Washington University School of Medicine, District of Columbia
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Aisha Barber Davis
Division of Hospitalist Medicine, Children’s National Medical Center and The George Washington University School of Medicine, District of Columbia
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Padmaja Pavuluri
Division of Hospitalist Medicine, Children’s National Medical Center and The George Washington University School of Medicine, District of Columbia
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Abstract

Objectives: This study describes blood culture collection rates, results, and microbiology laboratory charges for 4 leading pediatric inpatient diagnoses (asthma, bronchiolitis, pneumonia, and skin and soft tissue infection [SSTI]) in low-risk patients.

Methods: This retrospective cohort study was conducted at an urban, academic, quaternary children’s hospital. The study period was from January 1, 2011, to December 31, 2011. Inclusion criteria were as follows: 6 months to 18 years of age and primary diagnosis of asthma (International Classification of Diseases, Ninth Revision [ICD-9] codes 493.91–493.92), bronchiolitis (ICD-9 codes 466.11 and 466.19), SSTI (ICD-9 codes 680.00–686.99), or pneumonia (community-acquired pneumonia; ICD-9 codes 481.00–486.00). Patients with complex chronic conditions were excluded. Data were collected via administrative billing data and chart review. Descriptive statistics were performed; χ2 tests were used for categorical variables, and nonparametric tests were used for continuous variables because of non-normal distributions.

Results: Administrative data review included 5159 encounters, with 1629 (32%) inpatient encounters and 3530 (68%) emergency department/outpatient encounters. Twenty-one percent (n = 343) of inpatient encounters had blood cultures performed, whereas 3% (n = 111) of emergency department/outpatient encounters had blood culture testing performed. Inpatient blood culture utilization varied according to diagnosis: asthma, 4%; bronchiolitis, 15%; pneumonia, 36%; and SSTI, 46%. Charts were reviewed for all 343 inpatients with blood culture testing. Results of all the blood cultures obtained for asthma and bronchiolitis admissions were negative, with 98% and 99% negative or false-positive (contaminant) for SSTI and community-acquired pneumonia, respectively. The approximate financial impact of blood culture utilization (according to gross microbiology laboratory charges) approximated $100 000 over the year for all 4 diagnoses.

Conclusions: There was a high rate of negative or false-positive blood culture results for these common inpatient diagnoses. In addition, there was a low rate of clinically significant true-positive (pathogenic) culture results. These results identify points of potential blood culture overutilization.

  • asthma
  • blood culture
  • bronchiolitis
  • clinical practice guidelines
  • community-acquired pneumonia
  • resource overutilization
  • skin and soft tissue infection
  • Abbreviations:
    CAP
    community-acquired pneumonia
    ED
    emergency department
    ICD-9
    International Classification of Diseases, Ninth Revision
    LOS
    length of stay
    MRSA
    methicillin-resistant Staphylococcus aureus
    SSTI
    skin and soft tissue infection
    • Copyright © 2014 by the American Academy of Pediatrics
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    Hospital Pediatrics: 4 (2)
    Hospital Pediatrics
    Vol. 4, Issue 2
    1 Mar 2014
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    Do We Need This Blood Culture?
    Kavita Parikh, Aisha Barber Davis, Padmaja Pavuluri
    Hospital Pediatrics Mar 2014, 4 (2) 78-84; DOI: 10.1542/hpeds.2013-0053

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    Do We Need This Blood Culture?
    Kavita Parikh, Aisha Barber Davis, Padmaja Pavuluri
    Hospital Pediatrics Mar 2014, 4 (2) 78-84; DOI: 10.1542/hpeds.2013-0053
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    Subjects

    • Hematology/Oncology
      • Hematology/Oncology
      • Blood Disorders
    • Pulmonology
      • Pulmonology
      • Asthma

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    • asthma
    • blood culture
    • bronchiolitis
    • clinical practice guidelines
    • community-acquired pneumonia
    • resource overutilization
    • skin and soft tissue infection
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