For children hospitalized with CAP, adjunct corticosteroids were associated with a shorter hospital LOS among patients who received concomitant β-agonist therapy. Among patients who did not receive this therapy, systemic corticosteroids were associated with a longer LOS and a greater odds of readmission. If β-agonist therapy is considered a proxy for wheezing, our findings suggest that among patients admitted to the hospital with a diagnosis of CAP, only those with acute wheezing benefit from adjunct systemic corticosteroid therapy.

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BACKGROUND:Mycoplasma pneumoniae is a common cause of community‐acquired pneumonia in childhood. Few studies have addressed the association of antimicrobial treatment and outcomes.OBJECTIVE:To determine whether macrolide therapy is associated with improved outcomes among children hospitalized with M. pneumoniae pneumonia.DESIGN:Multicenter retrospective cohort study.SETTING:Thirty‐six children's hospitals which contribute data to the Pediatric Health Information System.PATIENTS:Children 6‐18 years of age discharged with a diagnosis of M. pneumoniae pneumonia.MAIN EXPOSURE:Initial macrolide therapy.MAIN OUTCOME MEASURES:Length of stay (LOS), all‐cause readmissions, and asthma‐related hospitalizations.RESULTS:Empiric macrolide therapy was administered to 405 (58.7%) of 690 patients. The median LOS was 3 days (interquartile range, 2‐6 days). Eight (1.2 %) patients were readmitted within 28 days, and 160 (23.2%) were readmitted within 15 months of index discharge. Ninety‐five (13.7%) patients were hospitalized for asthma within 15 months of index discharge. Empiric macrolide therapy was associated with a 32% shorter overall LOS (adjusted beta‐coefficient, −0.38; 95% confidence interval [CI]: −0.59 to −0.17). Macrolide therapy was not associated with all‐cause readmission at 28 days (adjusted odds ratio, 1.12; 95% CI: 0.22‐5.78) or 15 months (adjusted odds ratio, 1.00; 95% CI: 0.59‐1.70) or with asthma‐related hospitalizations at 15 months (adjusted odds ratio, 0.85; 95% CI: 0.36‐1.97).CONCLUSION:In this large multicenter study of children hospitalized with M. pneumoniae pneumonia, empiric macrolide therapy was associated with a shorter hospital LOS. Macrolide therapy was not associated with 28‐day or 15‐month hospital readmission. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

ImportancePrior studies have revealed gender differences in the milestone and clinical competency committee assessment of emergency medicine (EM) residents.ObjectiveTo explore gender disparities and the reasons for such disparities in the narrative comments from EM attending physicians to EM residents.Design, Setting, and ParticipantsThis multicenter qualitative analysis examined 10 488 narrative comments among EM faculty and EM residents between 2015 to 2018 in 5 EM training programs in the US. Data were analyzed from 2019 to 2021.Main Outcomes and MeasuresDifferences in narrative comments by gender and study site. Qualitative analysis included deidentification and iterative coding of the data set using an axial coding approach, with double coding of 20% of the comments at random to assess intercoder reliability (κ, 0.84). The authors reviewed the unmasked coded data set to identify emerging themes. Summary statistics were calculated for the number of narrative comments and their coded themes by gender and study site. χ2 tests were used to determine differences in the proportion of narrative comments by gender of faculty and resident.ResultsIn this study of 283 EM residents, of whom 113 (40%) identified as women, and 277 EM attending physicians, of whom 95 (34%) identified as women, there were notable gender differences in the content of the narrative comments from faculty to residents. Men faculty, compared with women faculty, were more likely to provide either nonspecific comments (115 of 182 [63.2%] vs 40 of 95 [42.1%]), or no comments (3387 of 10 496 [32.3%] vs 1169 of 4548 [25.7%]; P < .001) to men and women residents. Compared with men residents, more women residents were told that they were performing below level by men and women faculty (36 of 113 [31.9%] vs 43 of 170 [25.3%]), with the most common theme including lack of confidence with procedural skills.Conclusions and RelevanceIn this qualitative study of narrative comments provided by EM attending physicians to residents, multiple modifiable contributors to gender disparities in assessment were identified, including the presence, content, and specificity of comments. Among women residents, procedural competency was associated with being conflated with procedural confidence. These findings can inform interventions to improve parity in assessment across graduate medical education.