Variation in lumbar punctures for early onset neonatal sepsis a nationally representative serial cross-sectional analysis, 2003-2009 英文参考文献.docVIP

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Variation in lumbar punctures for early onset neonatal sepsis a nationally representative serial cross-sectional analysis, 2003-2009 英文参考文献.doc

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Variation in lumbar punctures for early onset neonatal sepsis a nationally representative serial cross-sectional analysis, 2003-2009 英文参考文献

Patricketal.BMCPediatrics2012,12:134 /1471-2431/12/134 RESEARCH ARTICLE OpenAccess Variationinlumbarpuncturesforearlyonset neonatalsepsis:anationallyrepresentativeserial cross-sectionalanalysis,2003–2009 StephenWPatrick1,2,3*,RobertESchumacher1,3andMatthewMDavis1,2,4,5,6 Abstract Background:Whetherlumbarpunctures(LPs)shouldbeperformedroutinelyfortermnewbornssuspectedof havingearlyonsetneonatalsepsis(EONS)issubjecttodebate.Itisunclearwhethervariationsinperformanceof LPsforEONSmaybeassociatedwithpatient,hospital,insuranceorregionalfactors.Ourobjectivewastoidentify characteristicsassociatedwiththepracticeofperformingLPsforsuspectedEONSinanationallyrepresentative sample. Methods:Utilizingdatafromthe2003,2006and2009Kids’InpatientDatabase(KID)compiledbytheAgencyfor HealthcareResearchandQuality,weexaminedthefrequencyandcharacteristicsofterm,normal-birthweight newbornsreceivinganLPforEONS.Survey-weightingwasappliedfornationalestimatesandusedinchisquared andmultivariableregressionanalysis. Results:In2009,therewere13,694dischargesfortermnewbornsthatunderwentLPsforapparentEONS. NewbornshavingLPsperformedweremorelikelytobecoveredbyMedicaidvs.privateinsurance(51.9vs.45.1 percent;p0.001),beborninurbanvs.ruralhospitals(94.8vs.87.3percent;p0.001),teachingvs.non-teaching (60.8vs.43.1percent;p0.001)andchildren’shospitalsvs.non-children’s(23.0vs.11.2percent;p0.001). Lastly,newbornshavingLPsperformedweredisproportionatelybornintheNortheastcensusregion(p=0.03). Inmulti-yearadjustedanalysis,infantswithMedicaidcoverage,andthoseborninurbanorteachinghospitals, consistentlyhadhigheroddsofhavinganLPperformed. Conclusions:WefoundpronouncedvariationinLPsperformedforEONS,evenwhenadjustingforclinical conditionsthatwouldpromptLPs.Thesefindingsindicatepracticevariationsinnewborncarethatmeritfurther examinationandexplanation. Keywords:Neonatal,Sepsis,Lumbarpuncture,Variation,Earlyonsetneonatalsepsis Background EONS for risk factors related to maternal reasons [2-4] Lumbar punctures (LPs) are comm