P-110. Promoting Optimal Treatment for Community-Acquired Pneumonia in the Emergency Room: a Before-After Study of a Novel Care Pathway
Bibliographic record
Abstract
Abstract Background Community-acquired pneumonia (CAP) in young children is mainly caused by viral pathogens; for this reason, Infectious Disease Society of America guidelines explicitly state that antibiotic treatment of non-severe CAP in this population is not obligatory. However, the vast majority of non-severe pediatric CAP episodes diagnosed in North America prompt antibiotic prescription anyway. Methods A before-after prospective study was done in a Canadian emergency department (ED) enrolling children aged 6+ months without comorbidities diagnosed with CAP and managed as outpatients. In the before (control) phase, participants were managed as per routine care. In the after (intervention) phase, participants were managed using a novel care pathway. This care pathway used imaging results, a point-of-care C-reactive protein (POC CRP) assay, and other already-available data (eg. O2 saturation, respiratory rate, age) to categorize participants as ‘appreciable risk’ or ‘low risk.’ Those at ‘appreciable risk’ were given a prescription for antibiotics, whereas those at ‘low risk’ were simply discharged home. The next day, caregivers of ‘low-risk’ participants were informed of results of nasopharyngeal viral/atypical pathogen testing. Follow-up was done at day 2-5, 14-21, and 30. Results There were 84 participants recruited in the control phase (Mar-Nov 2022) and 78 in the intervention phase (Nov 2022-Mar 2024). Control phase participants had a median age of 2.8 y (IQR 2.1 – 4.4y) and 13% had normal chest imaging, whereas intervention phase participants had a median age of 3.7 y (IQR 1.9 – 6 y) and 5.1% had normal chest imaging. All 84 of the participants in the control phase were prescribed antibiotics at ED discharge, as compared to only 51% of those in the intervention phase (49% less, 95%CI 38-60% less, p< 0.001). There were no significant differences in clinical cure at day 2-5, re-presentation to the ED, later hospitalization, or caregiver satisfaction with the care plan. Conclusion A simple novel care pathway incorporating POC CRP testing as well as other available data facilitated a very clinically important decrease in antibiotic prescribing without compromising clinical outcomes. This care pathway should be evaluated in the context of a multicentre randomized trial. Disclosures Jeffrey Pernica, MD, MSc, FRCPC, DTMH, MedImmune: Grant/Research Support|Merck: Grant/Research Support Dominik Mertz, MD, MSc, KCI Inc. USA: Grant/Research Support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.014 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.011 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".