O0478 Oct.4: 4:24pm - Association between procalcitonin testing and patterns of ED care for infants aged <60 days undergoing evaluation for serious bacterial infection

Background: Febrile infants aged <60 days are at increased risk for serious bacterial infection (SBI). Procalcitonin may be used to risk stratify infants for SBI. Conceptually, ideal risk stratification would limit lumbar puncture (LP), empiric antibiotics, and hospitalization for low-risk infants.

Objective: We examined recent trends in procalcitonin testing and the association between procalcitonin testing and patterns of care for infants undergoing ED evaluation for SBI. We hypothesized that hospital-level procalcitonin testing would be associated with lower rates of LP, parenteral antibiotic administration, and hospitalization.
Design/

Methods: We performed a retrospective multicenter cross-sectional study using the Pediatric Health Information System database. Patients aged 0-60 days who underwent ED evaluation between 2017-2018 for SBI, as defined by collection of blood and urine cultures, were included. Temporal trends in procalcitonin use were examined. Multivariable logistic regression models were estimated with encounter-level LP, antibiotic administration, and hospitalization as the dependent variables and hospital-level and encounter-level procalcitonin testing as the independent variables (adjusted for demographic factors and utilizing robust standard errors to account for clustering by hospital). Analyses were conducted separately by age subgroups: 0-28 days and 29-60 days.

Results: 28,851 visits were studied, of which 12,148 (42%) were for infants aged 0-28 days. Procalcitonin testing increased 264% over the study period (Figure 1). Hospital-level procalcitonin testing was associated with a 59% decreased odds of encounter-level LP for infants 0-28 days, but there was no statistical association for infants 29-60 days (Table 1). Encounter-level procalcitonin testing was associated with a 48% and 38% increased odds of LP for infants aged 0-28 days and 29-60 days, respectively, despite controlling for clustering by hospital. There was no association between encounter-level procalcitonin testing and hospitalization or antibiotic administration for either subgroup.

Conclusion: For infants undergoing ED evaluation for SBI, hospital-level procalcitonin testing was associated with a decreased odds of LP for infants 0-28 days. There was no association between hospital- level procalcitonin testing and LP for infants 29-60 days.