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J Pediatr. 2015 Dec;167(6):1340-6.e9. doi: 10.1016/j.jpeds.2015.09.021. Epub 2015 Oct 21.

Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days.

Author information

1
Division of Emergency Medicine at Boston Children's Hospital, Boston, MA. Electronic address: kaopingchua@uchicago.edu.
2
Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
3
Department of Health Care Policy, Harvard Medical School, Boston, MA; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
4
Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT.

Abstract

OBJECTIVE:

To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days.

STUDY DESIGN:

Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year.

RESULTS:

The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI -0.18 to 0.85; P = .22).

CONCLUSIONS:

Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.

PMID:
26477870
PMCID:
PMC5535778
DOI:
10.1016/j.jpeds.2015.09.021
[Indexed for MEDLINE]
Free PMC Article

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