365 - Antibiotic Use and Impact on Illness Course in Children with Influenza-Like-Illness in the Emergency Department

Poster Number: 365
Publication Number: 365.206

Nicole M. Poole, University of Colorado, Denver, CO, United States; ANGELA MOSS, ACCORDS, University of Colorado, Aurora, CO, United States; Krithika Suresh, Colorado School of Public Health, Denver, CO, United States; Sean T. O'Leary, University of Colorado School of Medicine, Denver, CO, United States; Suchitra Rao, University of Colorado School of Medicine, Aurora, CO, United States

Background: Child absenteeism from childcare or school leads to economic loss from parental work absenteeism, overutilization of acute care resources, and excess medicalization of children with minor illnesses.

Objective: To determine the difference in days missed from childcare/school and days of illness for children with influenza-like-illness (ILI) in the Emergency Department (ED) who are prescribed or not prescribed an antibiotic.

Design/Methods: A secondary data analysis of a prospective randomized control trial evaluating the impact of rapid molecular testing on provider decision making. Children aged 2 mos-12 yrs attending childcare/school seen in the ED from Dec 2018-Dec 2019 with ILI (CDC definition) with parental survey completion 10 days after initial ED visit were included. The primary exposure was receipt of antibiotics over the course of illness (assessed by chart review and parent survey). The primary outcome was number of days missed from class. The secondary outcome was number of days of illness after initial ED visit. Wilcoxon tests were used to compare missed class days or illness days by antibiotic receipt. Multivariable negative binomial regression was used to analyze outcomes, controlling for clinically important patient characteristics.

Results: Of 251 children included in this study, the median age was 4.2 (interquartile range: 1.6, 7.0) yrs, with 52% male, 40% White, 54% Hispanic and 75% with government insurance. Antibiotics were prescribed in 26% of ILI encounters. There was no statistically significant association between antibiotic receipt and number missed class days or illness days after initial ED visit (Table 1). Adjusting for covariates, there was no significant difference in missed class days or illness days for patients prescribed antibiotics in relation to days sick before initial ED visit (Table 2). The rate of missed class days and illness days was 87% and 30% greater, respectively, in patients with additional medical visits during the course of illness (p < 0.005 for both).Conclusion(s): Severity of illness inferred from days sick prior to ED presentation and receipt of an antibiotic for ILI had no influence on child absenteeism or illness duration. However, children missed more class and received more antibiotics if they had multiple medical visits during an illness. Further study is needed on sociobehavioral factors leading to medicalization of children with minor illnesses and its impact on unnecessary use of antibiotics.
Table 1: Number of missed class days and number of illness days after Emergency Department (ED) visit for influenza-like-illness.
Table 2: Multivariable negative binomial regression models of missed class days and illness days within 10 days after Emergency Department (ED) visit for influenza-like-illness.*Other covariates in model included: age, gender, race, ethnicity, insurance, randomization group, high risk medical condition, vaccination status, smoke exposure