STRATEGIES FOR DIAGNOSIS AND TREATMENT OF CHILDREN AT RISK FOR OCCULT BACTEREMIA - CLINICAL EFFECTIVENESS AND COST-EFFECTIVENESS

被引:46
作者
LIEU, TA
SCHWARTZ, JS
JAFFE, DM
FLEISHER, GR
机构
[1] UNIV PENN, SCH MED, DEPT PEDIAT, PHILADELPHIA, PA 19104 USA
[2] UNIV PENN, SCH MED, DEPT MED, GEN INTERNAL MED SECT, PHILADELPHIA, PA 19104 USA
[3] UNIV PENN, SCH MED, DEPT MED, CLIN EPIDEMIOL UNIT, PHILADELPHIA, PA 19104 USA
[4] UNIV PENN, WHARTON SCH, DEPT HLTH CARE SYST, PHILADELPHIA, PA 19104 USA
[5] UNIV PENN, LEONARD DAVIS INST HLTH CARE ECON, PHILADELPHIA, PA 19104 USA
[6] UNIV TORONTO, DEPT PEDIAT, DIV EMERGENCY MED, TORONTO M5S 1A1, ONTARIO, CANADA
[7] HARVARD UNIV, SCH MED, DEPT PEDIAT, DIV EMERGENCY MED, BOSTON, MA 02115 USA
关键词
D O I
10.1016/S0022-3476(05)81838-4
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Decision analysis was used to evaluate the probable health benefits, complications, and costs of six management strategies for febrile children at risk for occult bacteremia. The strategy that combined blood culture with empiric oral antibiotic treatment for all patients was predicted to prevent the highest number of major infections and to have the lowest cost per major infection prevented. The stragegy that combined a leukocyte count and blood culture for all patients, followed by empiric antibiotic treatment for those with leukocyte count greater-than-or-equal-to 10,000/mm3, had almost equal cost and clinical effectiveness and avoided many antibiotic complications. Culture of blood specimens from all patients and no empiric treatment constituted the third most clinically effective intervention but was the least cost-effective in this model. Giving a 2-day oral course of amoxicillin without testing had the lowest average cost per febrile patient but was the least clinically effective intervention. However, the low degree of effectiveness of empiric treatment alone was based on the assumption that oral amoxicillin therapy was only 20% effective in preventing major infections after bacteremia. At higher estimates of effectiveness, treatment alone became a more viable strategy. We conclude that approaches which combine blood culture with empiric antibiotic treatment are the most clinically effective and the most cost-effective strategies for children at risk for occult bacteremia.
引用
收藏
页码:21 / 29
页数:9
相关论文
共 27 条
  • [11] DOWNS SM, 1989, MED DECIS MAKING, V9, P320
  • [12] ISAACMAN DJ, 1989, ARE 2 BLOOD CULTURES
  • [13] ANTIBIOTIC ADMINISTRATION TO TREAT POSSIBLE OCCULT BACTEREMIA IN FEBRILE CHILDREN
    JAFFE, DM
    TANZ, RR
    DAVIS, AT
    HENRETIG, F
    FLEISHER, G
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1987, 317 (19) : 1175 - 1180
  • [14] JAFFE DM, IN PRESS PEDIATRICS
  • [15] KRAMER MS, 1989, PEDIATRICS, V84, P18
  • [16] KRAMER MS, 1989, AM J DIS CHILD, V143, P436
  • [17] UNSUSPECTED BACTEREMIA DUE TO HEMOPHILUS-INFLUENZAE - OUTCOME IN CHILDREN NOT INITIALLY ADMITTED TO HOSPITAL
    MARSHALL, R
    TEELE, DW
    KLEIN, JO
    [J]. JOURNAL OF PEDIATRICS, 1979, 95 (05) : 690 - 695
  • [18] MCCARTHY PL, 1982, PEDIATRICS, V70, P802
  • [19] MCCARTHY PL, 1977, PEDIATRICS, V59, P663
  • [20] MCCARTHY PL, 1976, PEDIATRICS, V57, P861