727 - Electrolyte Testing Variability Among Critically Ill Children with Viral Bronchiolitis

Monday, May 1, 2023

9:30 AM – 11:30 AM ET

Poster Number: 727
Publication Number: 727.401

Patrick Snyder, Children's Hospital Colorado, Denver, CO, United States; Blake Martin, University of Colorado School of Medicine, Denver, CO, United States; Michael J. Tchou, University of Colorado Anschutz and Children's Hospital of Colorado, Aurora, CO, United States

Presenting Author(s)

Patrick Snyder, MD, MBA (he/him/his)

Critical Care Medicine Fellow
Children's Hospital Colorado
Denver, Colorado, United States

Background: Healthcare spending in pediatrics is increasing rapidly, with a significant proportion of spending categorized as overuse. Overuse of commonly repeated tests, such as serum electrolytes, contributes substantially to health care waste and unintended downstream patient effects. Knowledge of electrolyte test utilization in pediatric intensive care units (PICUs) is lacking. Understanding patterns of variation could inform waste-reduction efforts.

Objective:

To identify patterns of electrolyte testing among children with viral bronchiolitis admitted to PICUs from within a national database.

Design/Methods: We conducted a multicenter retrospective cohort study of otherwise healthy PICU patients with a primary admission diagnosis of bronchiolitis. We gathered billing data from 44 children’s hospitals using the Pediatric Health Information System (PHIS) from 2017 to 2021. Children with a complex medical condition, who were intubated, or who received electrolyte altering medications (e.g. diuretics) were excluded. Initial electrolyte testing was defined as any electrolyte test occurring within the PICU encounter after appropriate exclusion criteria, with repeat testing defined as any subsequent testing within the same PICU encounter. Descriptive statistics were used to compare rates of initial and repeat testing across centers. Linear regression was performed to compare the association between overall and repeat testing rates.

Results: Among 19,281 patients, 23% (4,516/19,281) received some form of electrolyte testing. Wide variation was observed across hospitals for overall, initial and repeat testing rates (Figure 1). Higher PICU-level testing rates were associated with increased rates of subsequent testing: for each 1% increase in the overall electrolyte testing percentage, there was a 0.76% (95% CI 0.22%-1.29%) increase in the rate of multiple testing, an association that was statistically significant (p = 0.007).

Conclusion(s):

Among PICU bronchiolitis admissions across 44 children’s hospitals, rates of initial and repeat electrolyte testing varied widely. PICU-level rates of initial testing were associated with rates of subsequent testing. These results may suggest the overuse of electrolyte testing among critically ill children admitted for a common condition. Future work could inform design of guidelines to improve the value of electrolyte testing in the pediatric intensive care setting.