scholarly journals 1160. Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S671-S672
Author(s):  
Elisabeth Hoyer ◽  
Marritta Joseph ◽  
Sheldon L Kaplan ◽  
Jesus G Vallejo ◽  
Jonathon C McNeil
Keyword(s):  
Relative Frequency ◽  
Penetrating Trauma ◽  
Empiric Therapy ◽  
Healthy Children ◽  
Research Support ◽  
Laboratory Findings ◽  
Laboratory Parameters ◽  
Hematogenous Osteomyelitis ◽  
Acute Hematogenous Osteomyelitis ◽  
Research Grant

Abstract Background Acute hematogenous osteomyelitis (AHO) is a serious infection in children. ESPID guidelines recommend empiric therapy with antistaphylococcal β-lactams in regions with a low methicillin-resistant S. aureus (MRSA) prevalence. In areas with a moderate-high prevalence of MRSA, selection of empiric therapy can be more challenging. We sought to examine factors present at the time of admission which may predict etiology and guide treatment in pediatric AHO in a region with endemic MRSA. Methods We reviewed admissions with ICD9/10 codes for AHO from 2011-2020 in otherwise healthy children. Patients with chronic infection, open or penetrating trauma, orthopedic hardware in situ, or disease secondary to a contiguous focus were excluded. Medical records were reviewed for clinical and laboratory parameters present on the day of admission. Results 586 cases were included. An etiology was identified in 76.8% of cases and S. aureus was most commonly identified (66.2%, 19% MRSA, Figure 1). Infection due to Kingella kingae (0.7%) occurred in younger children (p=0.01). Significant differences in presenting features were noted across pathogens, although S. aureus dominated in all sub-groups (Figure 2). Among children with respiratory symptoms at presentation, Group A Streptococcus (GAS, 10.7%), and S. pneumoniae (2.6%, p=0.01) were identified twice as frequently. Among children with reptiles exposure, Salmonella was identified in 10.8% (p=0.04). Multifocal infections and those requiring ICU admission were due to S. aureus in 88% and 97% of cases, respectively; these cases were disproportionately MRSA (36.4%, p=0.01 and 54%, p< 0.001). Both ESR and CRP were higher among MRSA compared to any other pathogen (Figure 3, p< 0.01). A CRP at presentation > 7 mg/dl had a 79.6% sensitivity for MRSA infection with a negative predictive value of 91.5%. Among those with either an ESR > 50 mm/hr or a CRP > 7 mg/dl, an organism was identified in 83.2% Depiction of the relative frequency of major pathogens among a cohort of 586 cases of acute hematogenous osteomyelitis in children Depiction of the relative frequency of different organisms in children with AHO with various history, exam and laboratory findings Scatterplot depicting ESR and CRP levels across major hematogenous osteomyelitis pathogens Conclusion Subtle differences in symptoms, history and laboratory parameters can provide clues to etiology in pediatric AHO. A CRP > 7 mg/dl at time of presentation is suggestive of MRSA AHO, and this should be considered when planning empiric therapy. Likewise, the absence of extreme elevation of CRP may serve an antibiotic stewardship role in MRSA endemic regions. Disclosures Sheldon L. Kaplan, MD, Pfizer (Research Grant or Support) Jonathon C. McNeil, MD, Agency for Healthcare Research and Quality (Research Grant or Support)Allergan (Grant/Research Support)Nabriva (Grant/Research Support, Other Financial or Material Support, Site PI for a multicenter trial)

scholarly journals 1193. Mucosal Antibody Responses to Respiratory Syncytial Virus (RSV) in Infants and Young Children

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S688-S688
Author(s):  
Cristina Tomatis Souverbielle ◽  
Fang Ye ◽  
Sara Mertz ◽  
Mark E Peeples ◽  
Octavio Ramilo ◽  
...  
Keyword(s):  
Disease Severity ◽  
Panel Member ◽  
Healthy Children ◽  
Upper Respiratory Tract ◽  
Limited Information ◽  
Research Support ◽  
Review Panel ◽  
Rsv Infection ◽  
Syncytial Virus ◽  
Research Grant

Abstract Background The burden associated with RSV infection is substantial. Although RSV initially infects the upper respiratory tract, there is limited information of the mucosal concentrations of antibodies (Abs) directed to RSV specific proteins and whether patient’s age and disease severity influence production of mucosal Abs. Methods From 2017 to2019 we enrolled previously healthy children < 2 years of age hospitalized with RSV infection and obtained acute and convalescent (day; D30) nasopharyngeal (NP) samples to measure preF and postF specific IgG and IgA Abs by ELISA. Demographic and clinical data were collected and analyzed according to Abs responses. Results We enrolled 77 children (median [IQR] age: 2.8 [1.5-5.2] months; 49 % females) within the first 24 hours of hospitalization. Of those 25 (33%) patients required PICU care. A significant increase in convalescent IgG preF Abs titers was detected in 62 (81%) children, while IgA preF titers significantly increased in all but one child on D30. The magnitude of the increase was 56-fold higher for preF IgA versus preF IgG (p< 0.0001). PostF IgG and IgA titers were also increased on D30 but at significant lower levels. Infants < 3 months of age compared with those >3-24 months had significantly higher baseline preF and postF IgG Abs titers (p < 0.001) but not IgA antibodies. D30 preF and post F IgG titers were higher in children > 6 months of age (p < 0.0001) but only preF titers fold change significantly correlated with age (r=0.4, p< 0.0001). These correlations were not identified with IgA preF antibodies. There were no statistical differences in antibody titers at baseline and on D30 according to breastfeeding, and disease severity as defined by the need for PICU care. Conclusion Children hospitalized with RSV infection demonstrated significantly increased titers of mucosal preF and post F IgG and IgA specific Abs in convalescent samples. Baseline IgG Abs where higher in younger infants, which likely reflects maternally acquired antibodies. Age significantly correlated with Abs production, suggesting a more robust immune response in older children. Disclosures Mark E. Peeples, PhD, Janssen (Research Grant or Support)Pfizer (Research Grant or Support) Octavio Ramilo, MD, Adagio (Consultant)Bill & Melinda Gates Foundation (Grant/Research Support)Janssen (Grant/Research Support)Lilly (Consultant)Merck (Consultant, Grant/Research Support)NIH (Grant/Research Support)Pfizer (Consultant)SANOFI (Board Member) Asuncion Mejias, MD, PhD, MsCS, Janssen (Grant/Research Support, Advisor or Review Panel member)Merck (Grant/Research Support, Advisor or Review Panel member)Roche (Advisor or Review Panel member)Sanofi (Advisor or Review Panel member)

scholarly journals 1366. Microbiology of Acute Hematogenous Osteomyelitis in Hospitalized Children

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S693-S693
Author(s):  
Nina Hu ◽  
Rana F Hamdy ◽  
Benjamin Martin
Keyword(s):  
Penetrating Trauma ◽  
Positive Culture ◽  
Local Source ◽  
Acute Osteomyelitis ◽  
Surgical Specimen ◽  
Hematogenous Osteomyelitis ◽  
Acute Hematogenous Osteomyelitis ◽  
Average Patient ◽  
Resistance Patterns ◽  
Antibiotic Resistance Patterns

Abstract Background Acute hematogenous osteomyelitis affects 1 in 5,000 children in the U.S. and Staphylococcus aureus is the most common bacterial cause. At our institution, clindamycin is used empirically for osteomyelitis, despite increasing clindamycin-resistance over the years. The objective of this study is to describe microbiologic results and antibiotic resistance patterns in children hospitalized with acute hematogenous osteomyelitis. Methods This was a single-center retrospective cohort study of patients < 21 years of age with acute osteomyelitis hospitalized between 1/1/2010 and 5/31/2019 at Children’s National Hospital. We excluded patients with recent orthopedic surgery, hardware infection, penetrating trauma, or with an underlying immunocompromising condition. We performed chart review to collect data on location of infection; blood, synovial fluid, or surgical site cultures; culture results, and susceptibilities. Results Of the 162 encounters of acute osteomyelitis that met inclusion criteria, the average patient age was 8.3 years. Lower extremity infections were most common (105, 64.8%), followed by upper extremity (31, 19.1%), pelvis (14, 8.6%), spine (7, 4.3%), shoulder (4, 2.5%), rib (1, 0.6%) and mandible (1, 0.6%). Almost half of cases (73, 45%) had no positive cultures, and 89 cases (55%) had at least one positive culture from blood or local source (Figure 1). The most common pathogen was methicillin susceptible S. aureus (MSSA) followed by methicillin resistant S. aureus (MRSA) comprising 60 (67%) and 19 (20%) of culture-positive infections respectively. Other isolated pathogens included S. pyogenes (5, 5.6%) Salmonella species (2, 2.2%), S. pneumoniae (1, 1.1%), S. agalactiae (1, 1.1%), and Kingella kingae (1, 1.1%) (Figure 1). Among S. aureus infections, 69 (87%) were susceptible to clindamycin (85% among MSSA, 95% among MRSA). Categorized Blood and Wound Culture Results Conclusion Almost half of all children with acute hematogenous osteomyelitis did not have any microbiologic data to guide antibiotic usage. S. aureus was the most common (87%) isolate, with more MSSA (74%) than MRSA (24%). Non-S. aureus isolates were more likely to grow from surgical specimen cultures than from blood cultures. Clindamycin resistance was more commonly seen in MSSA than in MRSA osteomyelitis. Disclosures All Authors: No reported disclosures

scholarly journals 347. SARS-CoV-2 and Acute Otitis Media in Children: A Case Series

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S278-S278
Author(s):  
Holly M Frost ◽  
Thresia Sebastian ◽  
Amy Keith ◽  
Melanie Kurtz ◽  
Samuel R Dominguez ◽  
...  
Keyword(s):  
Otitis Media ◽  
Statistical Significance ◽  
Acute Otitis Media ◽  
Case Series ◽  
Series Data ◽  
Research Support ◽  
Laboratory Findings ◽  
Viral Pathogen ◽  
High Index Of Suspicion ◽  
Research Grant

Abstract Background Reports in adults with COVID-19 and acute otitis media (AOM) show that severe symptoms and hearing loss may be more common than with the clinical presentation of typical AOM. However, the association of SARS-CoV-2 with AOM in children is poorly understood. Methods Cases were identified as a subpopulation enrolled in the NOTEARS prospective AOM study in Denver, CO from March-December 2020. Children enrolled were 6-35 months of age with uncomplicated AOM and prescribed amoxicillin. Children diagnosed with AOM and SARS-CoV-2, detected by polymerase chain reaction assay, were included in the case series. Data was obtained from electronic medical records and research case report forms. Patients completed surveys at enrollment and 5, 14 and 30 days after enrollment that included the Acute Otitis Media Severity of Symptoms (AOM-SOS©) scale. All patients had nasopharyngeal otopathogen testing completed. Results A total of 108 patients had been enrolled through December 2020 (all of whom were subsequently tested for SARS CoV-2). During the study period for this case series, 16 patients were enrolled, and 7 (43.6%) were identified with AOM/SARS-CoV-2 co-infection. Among these 7 patients, fever was present in 3 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had testing for SARS CoV-2 as part of their clinical workup. Mean AOM-SOS© scores were similar among the SARS CoV-2 positive and negative patients with no statistical significance noted with two-sided t-tests: 13.6 (± 4.5) vs 14.2 (± 4.9) at enrollment, 1.4 (± 1.8) vs 4.2 (±4.9) on Day 5, and 0.6 (± 0.9) vs. 2.5 (±6.1) on Day 14 (Table 1). Among the 7 patients, no child had an AOM treatment failure or recurrence. Of the 6 patients in whom bacterial and viral testing have been completed, a bacterial otopathogen was identified in 6 (100%), and a viral pathogen in 3 (50%) children (Table 2). Table 1. Clinical features of children with concurrent SARS-CoV-2 and AOM Table 2. Laboratory findings of children with concurrent SARS-CoV-2 and AOM. Conclusion SARS-CoV-2 can occur in children with AOM. It is important that providers maintain a high index of suspicion for COVID-19 even in patients with clinical evidence of AOM, particularly to ensure families are appropriately advised on isolation and quarantine requirements. AOM with SARS-CoV-2 does not appear to be more severe than AOM without SARS-CoV-2. Disclosures Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support

scholarly journals 1174. Phase 3 Study to Evaluate the Safety, Tolerability, and Immunogenicity of Catch-up Vaccination Regimens of V114 in Healthy Infants, Children, and Adolescents (PNEU–PLAN)

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S678-S678
Author(s):  
Natalie Banniettis ◽  
Jacek Wysocki ◽  
Leszek Szenborn ◽  
Wanatpreeya Phongsamart ◽  
Punnee Pitisuttithum ◽  
...  
Keyword(s):  
Research Study ◽  
Scientific Research ◽  
Panel Member ◽  
Healthy Children ◽  
Research Support ◽  
Review Panel ◽  
Phase 3 ◽  
Study Investigator ◽  
Catch Up ◽  
Research Grant

Abstract Background Despite widespread use of pneumococcal conjugate vaccines (PCVs) in children, morbidity and mortality caused by pneumococcal disease (PD) remain high, in part due to the emergence of disease caused by non-vaccine serotypes (STs). In addition, many children do not receive the recommended number of PCVs on schedule and, therefore, are at risk for PD. V114 is an investigational 15-valent PCV that contains two epidemiologically important STs, 22F and 33F, in addition to the 13 STs present in the licensed 13-valent PCV (PCV13; Prevnar 13™). This Phase 3 descriptive study evaluated the safety and immunogenicity of V114 and PCV13 when given as catch-up vaccination in children who are pneumococcal vaccine-naïve or previously immunized with lower valency PCVs. Methods Solicited adverse events (AEs) were collected for 14 days after each vaccination. Serious adverse events (SAEs) were collected throughout study participation. Immunogenicity was evaluated by anti-pneumococcal polysaccharide ST-specific immunoglobulin G (IgG) geometric mean concentrations (GMCs) at 30 days post-last vaccination. Results 606 healthy children, aged 7 months through 17 years, were randomized (double-blind) to receive V114 (n=303) or PCV13 (n=303) via age-appropriate catch-up vaccination schedules (Table 1). V114 had an acceptable safety profile and was well tolerated. Similar proportions of children aged 7–11 months and 2–17 years reported AEs in the V114 and PCV13 groups. A larger proportion of children aged 12–23 months reported AEs in the V114 group (79%) than the PCV13 group (59%). The proportion of children who reported SAEs was comparable among vaccination groups (V114 and PCV13, respectively, 7–11 months: 10.9%, 7.8%; 12–23 months: 6.5%, 6.3%; 2–17 years: 2.3%, 2.3%). No SAEs were reported to be vaccine-related, and no deaths occurred. At 30 days after the last PCV dose, ST-specific IgG GMCs were comparable for the 13 shared STs and were higher in the V114 group for 22F and 33F. Table 1. Catch-up vaccination schedules in V114-024 Conclusion Catch-up vaccination with V114 in healthy children aged 7 months through 17 years had an acceptable safety profile, was well tolerated, and provided comparable immune responses to the 13 serotypes shared with PCV13, and higher immune responses to serotypes 22F and 33F. Disclosures Natalie Banniettis, MD, Merck Sharp and Dohme (Employee, Shareholder) Jacek Wysocki, MD, PhD, GlaxoSmithKline (Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support)MSD (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)Pfizer (Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support) Mika Rämet, MD, PhD, MSD (Scientific Research Study Investigator) Ron Dagan, MD, Medimmune/AstraZeneca (Grant/Research Support, Scientific Research Study Investigator, Research Grant or Support)MSD (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau)Pfizer (Consultant, Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member, Research Grant or Support, Speaker’s Bureau) Lori Good, B.S., Merck & Co., Inc (Employee) Melanie Papa, BA, Merck Sharp and Dohme (Employee, Shareholder) Yaru Shi, PhD, Merck & Co., Inc (Employee) Luwy Musey, MD, Merck & Co., Inc. (Employee) Kara Bickham, MD, Merck Sharp and Dohme (Employee, Shareholder) Gretchen Tamms, B.S., Merck Sharp and Dohme (Employee, Shareholder) Richard McFetridge, B.S., Merck & Co., Inc (Employee) Robert Lupinacci, M.S, Merck & Co., Inc (Employee, Shareholder)

scholarly journals Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey

2019 ◽  
Vol 16 (19) ◽  
pp. 3557 ◽  
Author(s):  
Elena Chiappini ◽  
Elena Serrano ◽  
Luisa Galli ◽  
Alberto Villani ◽  
Andrzej Krzysztofiak ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Oral Therapy ◽  
Empirical Therapy ◽  
Empiric Therapy ◽  
Generation Cephalosporin ◽  
Oral Antibiotic ◽  
Hematogenous Osteomyelitis ◽  
Acute Hematogenous Osteomyelitis ◽  
First Choice ◽  
Amoxicillin Clavulanate

Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2–4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6%), or oxacillin alone (n = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers’ adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.

scholarly journals Special aspects of the support function of lower limbs in children with the consequences of unilateral lesion of the proximal femur with acute hematogenous osteomyelitis

2018 ◽  
Vol 6 (1) ◽  
pp. 14-22
Author(s):  
Igor E. Nikityuk ◽  
Yuriy E. Garkavenko ◽  
Elizaveta L. Kononova
Keyword(s):  
Regression Analysis ◽  
Proximal Femur ◽  
Lower Limb ◽  
Pediatric Patients ◽  
Lower Limbs ◽  
Healthy Children ◽  
Correlation And Regression Analysis ◽  
Hematogenous Osteomyelitis ◽  
Transverse Arch ◽  
Acute Hematogenous Osteomyelitis

Background. Acute hematogenous osteomyelitis in the lesion of the proximal femur causes hypofunction or destruction of the metaepiphyseal growth zone of the femur. Theoretically, this leads to the formation of orthopedic consequences, including shortening of the lower limb. Aim. The study aimed to examine the plantographic characteristics of the feet in children with a lesion of the proximal femur and analyze the influence of the regularities of plantar pressure distribution in the asymmetry of the load on the lower limbs. Material and methods. Total 15 pediatric patients aged 6–16 years with consequences of acute hematogenous osteomyelitis of the proximal femur and shortening of the affected lower limb by 1.0–6.0 cm were examined. In addition, 15 healthy children belonging to the same age were examined for comparison. Stabilometry and plantography methods were used, and the statistical study included correlation and regression analysis. Results. When we conducted tests with a double-support load on the feet, in comparison to healthy children, pediatric patients exhibited a significant decrease in the value of the anterior index of the support t in both the affected and unaffected sides. The parameters of other support indices (namely, m, s, and l) of the contralateral feet in patients were within the normal range, indicating the functional consistency of the corresponding arches of the feet, providing static and dynamic limb support ability. However, the correlation and regression analysis showed that, in comparison with the norm, the foot support ability in pediatric patients is implemented due to the strengthening of the functional relationship between the inner and the medial longitudinal arches of the foot on the intact side and the inversion of the interaction of the longitudinal arches with the transverse arch on the side of the lesion. Conclusion. In children with consequences of acute hematogenous osteomyelitis of the proximal femur, the parameters of the plantographic characteristics indicate a change in the activity and consistency of the muscles that form all the feet arches on both the affected and intact lower limbs.

scholarly journals 57. Evaluating the Utility of a Penicillin Allergy Reconciliation Program within an Infectious Diseases Consult Population in a Community Health System

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S49-S50
Author(s):  
Bruce M Jones ◽  
Emily Plauche ◽  
Susan E Smith ◽  
Christopher M Bland
Keyword(s):  
Infectious Diseases ◽  
Health System ◽  
Community Health ◽  
Intervention Program ◽  
Primary Outcome ◽  
Panel Member ◽  
Penicillin Allergy ◽  
Secondary Outcome ◽  
Research Support ◽  
Research Grant

Abstract Background Penicillin allergy reconciliation is an important aspect of antimicrobial stewardship with ~10% of the population reporting a penicillin allergy. Our facility utilizes a Penicillin Allergy Reconciliation Program (PARP) led by an Infectious Diseases (ID) Pharmacist and pharmacy students to identify patients with penicillin allergies to reconcile and intervene when necessary. Information is collected by interview, electronic medical record (EMR) review, prescription outpatient fill history. This study evaluated reconciliations with and without a PARP in patients in a community health system. Methods This was a retrospective study that compared reconciliations performed on adult patients admitted at least once in 2019 with a self-reported penicillin allergy and ID physician consult at a hospital with a PARP (Institution 1) and one without a formal evaluation and intervention program (Institution 2) within the same community health system with same ID physicians. The primary outcome was documented reconciliation of a patient’s penicillin allergy during an inpatient visit in 2019. Reconciliation was defined as an edit or clarification (updating the severity, reaction, or comments section, as well as deleting) to a patient’s penicillin allergy in the EMR. The secondary outcome evaluated the percentage of total and ID consult patients with a penicillin allergy. Results There were 245 patients who met criteria and were included in the study, 113 from Institution 1 and 132 from Institution 2. For the primary outcome, there were 82 (72.6%) reconciliations at Institution 1 and 15 (11.4%) reconciliations at Institution 2 (p &lt; 0.001). Interventions at Institution 1 and 2 resulted in 74 EMR updates and 8 removals and 14 EMR updates and 1 removal, respectively. Reconciliation was performed on the same visit as the ID consult in 59/82 patients (72%) at Institution 1 and 11/15 patients (73.3%) at Institution 2. All reconciliations at Institution 2 were made by pharmacist (10) or nurses (5). For the secondary outcome, 10.9% of patients with an ID consult and 12.6% of all patients admitted in 2019 had a penicillin allergy (p=0.027). Conclusion A PARP led by an ID pharmacist and students was an effective method to perform penicillin allergy reconciliations, even in the presence of active ID consultation. Disclosures Bruce M. Jones, PharmD, BCPS, ALK-Abello (Research Grant or Support)Allergan/Abbvie (Speaker’s Bureau) Christopher M. Bland, PharMD, FCCP, FIDSA, BCPS, ALK Abello, Inc. (Grant/Research Support)Biomerieux (Consultant)Merck (Consultant, Grant/Research Support, Advisor or Review Panel member, Speaker’s Bureau)Tetraphase (Speaker’s Bureau)

scholarly journals AB1346-HPR REAL-WORLD EFFECTIVENESS AND PERCEIVED USEFULNESS OF SYMPTOM CHECKERS IN RHEUMATOLOGY: INTERIM REPORT FROM THE PROSPECTIVE MULTICENTER BETTER STUDY

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1961.1-1961
Author(s):  
J. Knitza ◽  
J. Mohn ◽  
C. Bergmann ◽  
E. Kampylafka ◽  
M. Hagen ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Real World ◽  
Search Engines ◽  
Correct Diagnosis ◽  
Perceived Usefulness ◽  
Symptom Duration ◽  
Research Support ◽  
Link Type ◽  
The Mean ◽  
Research Grant

Background:Symptom checkers (SC) promise to reduce diagnostic delay, misdiagnosis and effectively guide patients through healthcare systems. They are increasingly used, however little evidence exists about their real-life effectiveness.Objectives:The aim of this study was to evaluate the diagnostic accuracy, usage time, usability and perceived usefulness of two promising SC, ADA (www.ada.com) and Rheport (www.rheport.de). Furthermore, symptom duration and previous symptom checking was recorded.Methods:Cross-sectional interim clinical data from the first of three recruiting centers from the prospective, real-world, multicenter bETTeR-study (DKRS DRKS00017642) was used. Patients newly presenting to a secondary rheumatology outpatient clinic between September and December 2019 completed the ADA and Rheport SC. The time and answers were recorded and compared to the patient’s actual diagnosis. ADA provides up to 5 disease suggestions, Rheport calculates a risk score for rheumatic musculoskeletal diseases (RMDs) (≥1=RMD). For both SC the sensitivity, specificity was calculated regarding RMDs. Furthermore, patients completed a survey evaluating the SC usability using the system usability scale (SUS), perceived usefulness, previous symptom checking and symptom duration.Results:Of the 129 consecutive patients approached, 97 agreed to participate. 38% (37/97) of the presenting patients presented with an RMD (Figure 1). Mean symptom duration was 146 weeks and a mean number of 10 physician contacts occurred previously, to evaluate current symptoms. 56% (54/96) had previously checked their symptoms on the internet using search engines, spending a mean of 6 hours. Rheport showed a sensitivity of 49% (18/37) and specificity of 58% (35/60) concerning RMDs. ADA’s top 1 and top 5 disease suggestions concerning RMD showed a sensitivity of 43% (16/37) and 54% (20/37) and a specificity of 58% (35/60) and 52% (31/60), respectively. ADA listed the correct diagnosis of the patients with RMDs first or within the first 5 disease suggestions in 19% (7/37) and 30% (11/37), respectively. The average perceived usefulness for checking symptoms using ADA, internet search engines and Rheport was 3.0, 3.5 and 3.1 on a visual analog scale from 1-5 (5=very useful). 61% (59/96) and 64% (61/96) would recommend using ADA and Rheport, respectively. The mean SUS score of ADA and Rheport was 72/100 and 73/100. The mean usage time for ADA and Rheport was 8 and 9 minutes, respectively.Conclusion:This is the first prospective, real-world, multicenter study evaluating the diagnostic accuracy and other features of two currently used SC in rheumatology. These interim results suggest that diagnostic accuracy is limited, however SC are well accepted among patients and in some cases, correct diagnosis can be provided out of the pocket within few minutes, saving valuable time.Figure:Acknowledgments:This study was supported by an unrestricted research grant from Novartis.Disclosure of Interests:Johannes Knitza Grant/research support from: Research Grant: Novartis, Jacob Mohn: None declared, Christina Bergmann: None declared, Eleni Kampylafka Speakers bureau: Novartis, BMS, Janssen, Melanie Hagen: None declared, Daniela Bohr: None declared, Elizabeth Araujo Speakers bureau: Novartis, Lilly, Abbott, Matthias Englbrecht Grant/research support from: Roche Pharma, Chugai Pharma Europe, Consultant of: AbbVie, Roche Pharma, RheumaDatenRhePort GbR, Speakers bureau: AbbVie, Celgene, Chugai Pharma Europe, Lilly, Mundipharma, Novartis, Pfizer, Roche Pharma, UCB, David Simon Grant/research support from: Else Kröner-Memorial Scholarship, Novartis, Consultant of: Novartis, Lilly, Arnd Kleyer Consultant of: Lilly, Gilead, Novartis,Abbvie, Speakers bureau: Novartis, Lilly, Timo Meinderink: None declared, Wolfgang Vorbrüggen: None declared, Cay-Benedict von der Decken: None declared, Stefan Kleinert Shareholder of: Morphosys, Grant/research support from: Novartis, Consultant of: Novartis, Speakers bureau: Abbvie, Novartis, Celgene, Roche, Chugai, Janssen, Andreas Ramming Grant/research support from: Pfizer, Novartis, Consultant of: Boehringer Ingelheim, Novartis, Gilead, Pfizer, Speakers bureau: Boehringer Ingelheim, Roche, Janssen, Jörg Distler Grant/research support from: Boehringer Ingelheim, Consultant of: Boehringer Ingelheim, Paid instructor for: Boehringer Ingelheim, Speakers bureau: Boehringer Ingelheim, Peter Bartz-Bazzanella: None declared, Georg Schett Speakers bureau: AbbVie, BMS, Celgene, Janssen, Eli Lilly, Novartis, Roche and UCB, Axel Hueber Grant/research support from: Novartis, Lilly, Pfizer, Consultant of: Abbvie, BMS, Celgene, Gilead, GSK, Lilly, Novartis, Speakers bureau: GSK, Lilly, Novartis, Martin Welcker Grant/research support from: Abbvie, Novartis, UCB, Hexal, BMS, Lilly, Roche, Celgene, Sanofi, Consultant of: Abbvie, Actelion, Aescu, Amgen, Celgene, Hexal, Janssen, Medac, Novartis, Pfizer, Sanofi, UCB, Speakers bureau: Abbvie, Aescu, Amgen, Biogen, Berlin Chemie, Celgene, GSK, Hexal, Mylan, Novartis, Pfizer, UCB

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