Trial reportJournal of hospital medicine2023
Antibiotic clinical decision support for pneumonia in the ED: A randomized trial.
Trial report in Journal of hospital medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
6 citing papers in PubMed, 15 citations in OpenAlex.
- User-Centered Design and Implementation of an Interoperable FHIR Application for Pediatric Pneumonia Prognostication in a Randomized Trial.Applied clinical informatics · 2024Trial
- Parent and Clinician Perspectives on Diagnostic Testing for Children With Diarrhea: A Qualitative Study.JAMA network open · 2025Article
- Guideline-Concordant Antibiotic Use in Children With Community-Acquired Pneumonia.Hospital pediatrics · 2025Article
- Can we rely on artificial intelligence to guide antimicrobial therapy? A systematic literature review.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Separating the rash from the chaff: novel clinical decision support deployed during the mpox outbreak.Infection control and hospital epidemiology · 2024Article
- Limitations in the use of automated mental status detection for clinical decision support.International journal of medical informatics · 2023Article
Corrections and comments
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Authors and funding
23 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundElectronic health record-based clinical decision support (CDS) is a promising antibiotic stewardship strategy. Few studies have evaluated the effectiveness of antibiotic CDS in the pediatric emergency department (ED).
objectiveTo compare the effectiveness of antibiotic CDS vs. usual care for promoting guideline-concordant antibiotic prescribing for pneumonia in the pediatric ED.
designPragmatic randomized clinical trial. SETTING AND
participantsEncounters for children (6 months-18 years) with pneumonia presenting to two tertiary care children s hospital EDs in the United States.
interventionCDS or usual care was randomly assigned during 4-week periods within each site. The CDS intervention provided antibiotic recommendations tailored to each encounter and in accordance with national guidelines. MAIN OUTCOME AND MEASURES: The primary outcome was exclusive guideline-concordant antibiotic prescribing within the first 24 h of care. Safety outcomes included time to first antibiotic order, encounter length of stay, delayed intensive care, and 3- and 7-day revisits.
results1027 encounters were included, encompassing 478 randomized to usual care and 549 to CDS. Exclusive guideline-concordant prescribing did not differ at 24 h (CDS, 51.7% vs. usual care, 53.3%; odds ratio [OR] 0.94 [95% confidence interval [CI]: 0.73, 1.20]). In pre-specified stratified analyses, CDS was associated with guideline-concordant prescribing among encounters discharged from the ED (74.9% vs. 66.0%; OR 1.53 [95% CI: 1.01, 2.33]), but not among hospitalized encounters. Mean time to first antibiotic was shorter in the CDS group (3.0 vs 3.4 h; p = .024). There were no differences in safety outcomes.
conclusionsEffectiveness of ED-based antibiotic CDS was greatest among those discharged from the ED. Longitudinal interventions designed to target both ED and inpatient clinicians and to address common implementation challenges may enhance the effectiveness of CDS as a stewardship tool.
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