573 - Exploring Provider Perceptions and Practices in Managing Pediatric Aspiration Pneumonia

Publication Number: 2558.573

Katherine Pumphrey, Boston Children's Hospital, Boston, MA, United States; Kathleen D. Snow, Boston Children's Hospital, Boston, MA, United States; Maria Biancarelli, Boston Children's Hospital, SOUTH WALPOLE, MA, United States; Francisco E. Herrera Carrillo, Boston Children's Hospital, Brookline, MA, United States; Tregony Simoneau, Boston Children's Hospital, Boston, MA, United States; Walter Wickremasinghe, Boston Children's Hospital, Boston, MA, United States; Sangeeta Mauskar, Boston Childrens Hospital, Southboro, MA, United States; Stacie Haralambous, Boston Children's Hospital, Boston, MA, United States; Bianca Quinones-Perez, Boston Children's Hospital, Boston, MA, United States; Mari M. Nakamura, Boston Children's Hospital, Boston, MA, United States; Daniel Kelly, Boston Children's Hospital, Westwood, MA, United States; Sarah Jones, Boston Children's Hospital, Boston, MA, United States; Lucy Emery, Boston Children's Hospital, Boston, MA, United States; Niloufar Paydar-Darian, Boston Children's Hospital, Boston, MA, United States; Jana C. Leary, Boston Children's Hospital, Waban, MA, United States

Background: Aspiration pneumonia is a frequently considered diagnosis for children admitted for respiratory illness, especially children with medical complexity, yet clear diagnostic criteria/clinical practice guidelines do not exist. Despite limited pediatric literature, there may be opportunities to improve and standardize care for this population.

Objective: Explore provider perceptions on pediatric aspiration pneumonia diagnosis and management at a tertiary care children’s hospital, identify areas of variability, and determine leverage points to target for future QI initiatives.

Design/Methods: We conducted a cross-sectional survey of physicians, advanced practice providers, and trainees across multiple subspecialties including hospital pediatrics, critical care, pulmonology, emergency medicine and infectious diseases. Survey questions were designed using the Practical, Robust Implementation and Sustainability Model (PRISM) to assess current diagnostic reasoning practices, use of diagnostic tools, and antibiotic selection for suspected aspiration pneumonia. A REDCap survey was distributed to identified provider groups. Results were analyzed with descriptive statistics and subgroup analyses by provider type and specialty.

Results: 108 providers completed the survey (response rate 20%) [Table 1]. Chest x-rays (98%), inflammatory markers (72%), and respiratory viral testing (64%) were the most frequently ordered diagnostic tools. Elevated procalcitonin levels, focal infiltrates on chest imaging, and positive sputum culture were perceived as the most helpful diagnostic findings to differentiate between aspiration pneumonia and aspiration pneumonitis (Figure 1). Most providers (86%) reported being very or somewhat confident in selecting empiric antibiotics, though we found considerable variability in antibiotic choice and treatment duration across specialties (Table 2). Common challenges identified in managing this patient population included diagnostic uncertainty (81%), patient medical complexity (44%), concerns about antibiotic effectiveness (42%), and antimicrobial resistance (34%). While most providers agreed that standardizing care could improve outcomes, barriers included limited evidence and anticipated resistance to change.

Conclusion(s): Wide variability exists among pediatric providers in the diagnosis and management of aspiration pneumonia. These findings highlight opportunities to develop standardized diagnostic pathways, promote antimicrobial stewardship, and implement targeted educational interventions and clinical decision support to improve consistency and quality of care for this high-risk population.

Table 1
Table 1.pdfDemographics of Survey Participants

Table 2
Table 2.pdfAntibiotic Management for Aspiration Pneumonia by Medical Specialty

Figure 1
Figure 1.pdfDiagnostic Factors Used to Differentiate between Aspiration Pneumonitis and Aspiration Pneumonia