The primary objective was to evaluate hospital variation in intravenous (IV) acetaminophen use across pediatric patient populations. The secondary objective was to identify populations with high use of IV acetaminophen and wide variation in practice to identify priority areas for cost reduction and practice standardization.


We performed a retrospective study of children ≤18 years old hospitalized in 2019 in 48 US pediatric hospitals in the Pediatric Health Information System. Primary measures included IV acetaminophen use (percentage of encounters) and total days of therapy (DOT). A multivariable analysis identified clinical and demographic factors associated with IV acetaminophen use. High-priority groups for practice standardization were the All Patient Refined Diagnosis Related Groups in the top quartile of DOT, with wide variation of use across hospitals (interquartile range >50%).


Among 866 346 encounters, 14.4% received 1 dose of IV acetaminophen with 287 935 DOT, costing $29.8 million. In multivariable analysis age, payer, surgical procedure, ICU admission, total parenteral nutrition, and case mix index remained significantly associated with IV acetaminophen use. After multivariable adjustment, variation in hospital use ranged from <0.1% to 31% of all encounters. Twenty diagnosis groups accounted for 47% of total DOT (135 910 days) and 48% of cost ($14.2 million). Appendectomy, tonsil and adenoidectomy, and craniotomy were identified as top candidates for standardization efforts.


We observed large variation in IV acetaminophen use across pediatric hospitals and within diagnosis groups. These diagnoses represent candidates for practice standardization.

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