Thanks Doctor as Designer, and thanks for teaching me about Twitter.

Hi Michelle-Marie Peña, MD MSHP . Were you surprised to learn that other hospitals d/c a lot of their kids with osteo with PICCs? #jamapedsjc

Compare effectiveness and adverse outcomes of post-d/c antibiotic therapy administered via the PICC or the oral route. #jamapedsjc

T2/ If you look at figure 2, most commons site was lower ext, not surprisingly. PICC v. PO kids matched nicely on location #jamapedsjc #CER

T3/ Issue of variation across hospitals-- see Fig 2. kind of crazy, huh? #jamapedsjc #cer

T3/ One wouldn't think that the treatment you get for osteo has most to do with which hospital you are at. #jamapedsjc #cer

T3/ Exactly-- no assoc btwn hospital osteo volume and their preferred route of Rx. It's all about culture/hx. #jamapedsjc #cer

T3/ Even more remarkable-- there was at least one hospital at every decile of %PICC use. so we are all over the map. #jamapedsjc

T3/ This lack of standardization is both a quality and patient safety issue. #jamapedsjc

1/ Alok Patel @aaronmilstone Excellent point Alok. Our study was limited to hematog osteo. We excluded osteo after trauma. #jamapedsjc

2/ Alok Patel @aaronmilstone. so wouldn't extrapolate our results to those types of osteo. #jamapedsjc

3/ Alok Patel @aaronmilstone Perhaps we should look at that group too. Drugs with high oral bioavail should work there too #jamapedsjc

strengths were large sample size (pts and hospitals), chart review validation, rigorous matching methods, important question! #jamapedsjc

1/Propensity score is % probability patient would receive a PICC, based on a variety of factors. It was calculated for all pts #jamapedsjc

2/ within hospital matching matched PICC patient with oral patient who had same p-score at the same hospital, #jamapedsjc

3/ and compared outcomes. Across hospital matching matched PICC and oral pts with same p-score across all hospitals. #jamapedsjc

@jonmosser Charlene Wong, MD I agree. #jamapedsjc

1/ Doctor as Designer We looked specifically at that, as some docs worry about using oral abx for confirmed MRSA infection. No Difference!#jamapedsjc

Thanks everyone. This was a lot of fun. Spread the word! Ron #jamapedsjc

Trio of Studies Shows Oral Antibiotics Are As Good As IV Antibiotics After Discharge | Bench to Bedside shar.es/1DNU6v