Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing
Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing
复制标题
DOI：
10.1371/journal.pone.0199878
复制
发表时间：
2018-07-06
期刊：
影响因子：
3.7
通讯作者：
Cromwell, David A.
中科院分区：
文献类型：
--
作者：
Bielicki, Julia A.;Sharland, Mike;Cromwell, David A.
目的：区域儿科最后手段抗生素使用模式的评估受到来自人群差异的潜在混杂因素的阻碍。我们开发了一个风险调整模型，从现成的，国际上使用的调查数据和一个简单的病人分类，以帮助这样的comparation.DesignWe儿科保守抗生素（pCA）的暴露和患者/治疗特征来自全球点流行调查抗生素处方之间的关联，并开发了一个风险调整模型，采用多变量logistic回归。将具有不同预期pCA暴露水平的组的简单患者分类的性能与风险模型进行比较。设置5大洲41个国家的226个中心。1281名患者的新生儿和儿科住院败血症/血流感染抗生素处方。结果总体pCA暴露较高（35%），与每个变量密切相关（患者年龄、病房、基础疾病、社区获得或医院感染以及经验性或靶向治疗），所有这些都包括在最终的风险调整模型中。该模型表现出良好的区分度（c-统计量= 0.83）和校准（p = 0.38）。简单的分类模型表现出类似的歧视和校准的风险模型。区域pCA粗暴露率范围为10.3%（非洲）至67.4%（拉丁美洲）。风险调整大大减少了区域变化，调整后的利率范围从17.1%（非洲）到42.8%（拉丁美洲）。ConclusionsMore可比性的pCA暴露率可以通过使用几个容易收集的变量来产生风险调整率。
ObjectivesAssessment of regional pediatric last-resort antibiotic utilization patterns is hampered by potential confounding from population differences. We developed a risk-adjustment model from readily available, internationally used survey data and a simple patient classification to aid such comparisons.DesignWe investigated the association between pediatric conserve antibiotic (pCA) exposure and patient / treatment characteristics derived from global point prevalence surveys of antibiotic prescribing, and developed a risk-adjustment model using multivariable logistic regression. The performance of a simple patient classification of groups with different expected pCA exposure levels was compared to the risk model.Setting226 centers in 41 countries across 5 continents.ParticipantsNeonatal and pediatric inpatient antibiotic prescriptions for sepsis/bloodstream infection for 1281 patients.ResultsOverall pCA exposure was high (35%), strongly associated with each variable (patient age, ward, underlying disease, community acquisition or nosocomial infection and empiric or targeted treatment), and all were included in the final risk-adjustment model. The model demonstrated good discrimination (c-statistic = 0.83) and calibration (p = 0.38). The simple classification model demonstrated similar discrimination and calibration to the risk model. The crude regional pCA exposure rates ranged from 10.3% (Africa) to 67.4% (Latin America). Risk adjustment substantially reduced the regional variation, the adjusted rates ranging from 17.1% (Africa) to 42.8% (Latin America).ConclusionsGreater comparability of pCA exposure rates can be achieved by using a few easily collected variables to produce risk-adjusted rates.