Table 3:
Clinical and Financial Outcomes
| Category | Pre-Implementation Controls (n=1124) | Post-Implementation Cases (n=1127) | P Value |
|---|---|---|---|
|
| |||
| Clinical Outcomes | |||
| Hospitalized | 1024 (91%) | 1033 (92%) | 0.6929 |
| Length of Inpatient Stay (median days) | 4 (3, 9) | 4 (3, 9) | 0.9635 |
| Death During Hospitalization | 21 (2%) | 13 (1%) | 0.2264 |
| Death Due to CNS Infection | 6 (1%) | 7 (1%) | 1 |
| Started on IV Antibiotics | 799 (71%) | 768 (68%) | 0.1685 |
| Number of IV Antibiotics Received | 2 (2, 3) | 2 (2, 3) | 0.5326 |
| IV Antimicrobial Duration (hrs) | 36 (0, 60) | 24 (0, 50.4) | 0.0037 |
| IV Antimicrobial Hours (hrs) | 60 (0, 190) | 38 (0, 98) | 0.0007 |
| Received IV Acyclovir | 301 (27%) | 284 (25%) | 0.42 |
| Duration of IV Acyclovir Amongst Those Started (hrs) | 24 (8, 40) | 17 (8, 40) | 0.206 |
| Treatable Etiology Identified | 205 (18%) | 217 (19%) | 0.5799 |
| Time to Effective Antimicrobials for Children with Treatable Etiology (hrs) | 0.68 (0.48, 0.93) | 0.75 (0.43, 1.018) | 0.471 |
| Time to Effective Antimicrobials for Children with Treatable Organism in CSF (hrs) | 0.43 (0, 1.7) | 0.65 (0, 1.58) | 0.5817 |
|
| |||
| Time to Optimal Antimicrobial Regimen Initiation (hrs) a | 28 (25, 32) | 18 (13, 21) | <0.0001 |
|
| |||
| Cost Outcomes (median, IQR) | |||
| CSF Molecular Microbiology Testing Costs | $95 (0, 99) | $193 (99, 193) | <0.0001 |
| Total Microbiology Testing Costsb | $910 (631, 1267) | $1010 (684, 1321) | 0.0001 |
| Total Hospital Costsb | $15614 (9168, 34603) | $15507 (9408, 34602) | 0.9634 |
a
Cox Proportional Hazards Adjusted Analysis: The probability of receiving optimal antibiotics was 1.13 (95% CI: 1.04, 1.23) times higher in cases compared to controls after adjusting for age (<2 mo vs. >2 mo) and concern for encephalitis; p=0.004
b
Estimated costs derived by applying CHCO 2019 overall cost to charge ratio to hospital charges inflated to 2019 prices based on service date using 5% discount rate. Total hospital charges included all room & board, laboratory & radiology diagnostic, pharmacy & surgery treatment charges.