Title: Outpatient Treatment of Lower Respiratory Tract Infections in Children with Tracheostomy
Authors: Parevi Majmudar DO1, D.B. Sanders MD1, Andrew Beardsley MD2, James Slaven MS3, A. Ioana Cristea MD1
1 Division of Pulmonary, Allergy and Sleep Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
2Division of Pediatric Critical Care Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
3 Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN
Funding: None.
Meetings: This work will be presented at the virtual American Thoracic Society meeting in 2020.
Correspondence: Parevi Majmudar, 705 Riley Hospital Dr, ROC 4270, Indianapolis, IN 46202
Telephone: 317-948-0949, Fax: 317-944-5791
Email: Parevipm@gmail.com
Keywords: tracheitis, inhaled tobramycin, hospitalization, complex medical conditions
Abstract
RATIONALE: Outpatient treatment of lower respiratory tract infection (LRTI) in tracheostomy dependent children varies. The objective of this study was to identify whether increasing frequency of airway clearance (AWC) alone increased the odds of hospitalization within 28 days of treatment. Our hypothesis was that those treated with antibiotics were less likely to be hospitalized.
METHODS: We reviewed medical records of children who were tracheostomy dependent between 2012-2019 and followed at our institution. We recorded recommendations provided at each sick call or clinic visit, i.e. prescription of antibiotics and/or increase in frequency of AWC, for physician defined LRTI. Generalized estimating equation models were used to determine whether the recommendation to increase AWC frequency was associated with an increased risk of hospitalization within 4 weeks, as compared to the prescription of oral and/or inhaled antibiotics.
RESULTS: Among the 82 patients reviewed, there were 283 unique episodes of LRTI. Increasing AWC alone was recommended for 160 (45%) episodes and antibiotics were prescribed for 195 (55%) in addition to increasing AWC. Of those who received AWC only, 21.7% were hospitalized within 28 days of treatment, compared to 13.8% prescribed oral/inhaled antibiotics, p= 0.08. Those who received AWC alone did not have significantly higher odds of hospitalization within 28 days of treatment: adjusted OR 1.47 (95% CI: 0.75, 2.86); p=.26.
CONCLUSIONS: In this retrospective cohort study of pediatric patients with tracheostomy, a recommendation to increase AWC alone was not associated with increased odds of hospitalization compared to antibiotic prescriptions.