BACKGROUND National guidelines recommend antiviral treatment for children with influenza at high-risk for complications regardless of symptom duration. Little is known about concordance of clinical practice with this recommendation. METHODS We performed a cross-sectional study of outpatient children (1-18 years) at high-risk for complications who were diagnosed with influenza during the 2016-2019 influenza seasons using the MarketScan Medicaid database. High-risk status was determined using an existing definition including age, co-morbidities, and residence in a long-term care facility. The primary outcome was influenza antiviral dispensing within 2 days of influenza diagnosis. We determined patient and provider level factors associated with guideline concordant treatment using multivariable logistic regression. RESULTS Of the 274,213 children with influenza at high-risk for influenza complications, 11,4863 (58.1%) received antiviral treatment. Antiviral treatment was associated with the presence of asthma (adjusted odds ratio 1.13, 95% CI 1.11, 1.16), immunosuppression (aOR 1.10, 95% CI 1.05, 1.16), complex chronic conditions (aOR 1.04, 95% CI 1.01,1.07) and index encounter in the urgent care setting (aOR 1.3, 95% CI 1.26, 1.34). Factors associated with decreased odds of antiviral treatment include age 2-5 years compared to 6-17 years (aOR 0.95, 95% CI 0.93, 0.97), residing in a chronic care facility (aOR 0.61, 95% CI 0.46, 0.81), and index encounter in an emergency department (aOR 0.66, 95% CI 0.63, 71). CONCLUSIONS Among children with influenza at high-risk for complications, 42% did not receive guideline concordant antiviral treatment. Further study is needed to elucidate barriers to appropriate use of antivirals in this vulnerable population.

中文翻译：

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流感并发症高危儿童的一致抗病毒治疗指南

背景国家指南建议对并发症高风险的流感儿童进行抗病毒治疗，无论症状持续时间如何。对于临床实践与该建议的一致性知之甚少。方法 我们使用 MarketScan Medicaid 数据库对 2016-2019 流感季节期间被诊断患有流感的高并发症风险门诊儿童（1-18 岁）进行了横断面研究。高风险状态是使用现有定义确定的，包括年龄、合并症和长期护理机构的居住情况。主要结局是流感诊断后 2 天内配发流感抗病毒药物。我们使用多变量逻辑回归确定了与指南一致治疗相关的患者和提供者层面的因素。结果 在 274,213 名流感并发症高危儿童中，11,4863 名（58.1%）接受了抗病毒治疗。抗病毒治疗与哮喘（调整后比值比 1.13，95% CI 1.11，1.16）、免疫抑制（aOR 1.10，95% CI 1.05，1.16）、复杂慢性病（aOR 1.04，95% CI 1.01，1.07）相关以及紧急护理环境中的指数遭遇（aOR 1.3，95% CI 1.26，1.34）。与抗病毒治疗几率降低相关的因素包括年龄 2-5 岁与 6-17 岁相比（aOR 0.95，95% CI 0.93，0.97），居住在慢性病护理机构（aOR 0.61，95% CI 0.46，0.81），以及急诊科的指数遭遇（aOR 0.66，95% CI 0.63，71）。结论 在并发症高风险的流感儿童中，42% 的儿童没有接受符合指南的抗病毒治疗。需要进一步研究来阐明在这一弱势群体中适当使用抗病毒药物的障碍。