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J Emerg Med. 2019 Jun;56(6):583-591. doi: 10.1016/j.jemermed.2019.03.003. Epub 2019 Apr 20.

Practice Variation in the Evaluation and Disposition of Febrile Infants ≤60 Days of Age.

Author information

1
Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI.
2
Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA.
3
Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
4
Department of Emergency Medicine, Children's Hospital Colorado, Aurora, CO.
5
Department of Emergency Medicine, Western Michigan University, Kalamazoo, MI.
6
Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH.
7
Department of Pediatrics, Nemours/AI Dupont Hospital for Children, Wilmington, DE.
8
Department of Emergency Medicine, University of Michigan, Flint, MI.
9
Department of Pediatrics, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY.
10
Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL.
11
Department of Pediatrics, University of Utah; Salt Lake City, UT.
12
Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH.

Abstract

BACKGROUND:

Febrile infants commonly present to emergency departments for evaluation.

OBJECTIVE:

We describe the variation in diagnostic testing and hospitalization of febrile infants ≤60 days of age presenting to the emergency departments in the Pediatric Emergency Care Applied Research Network.

METHODS:

We enrolled a convenience sample of non-critically ill-appearing febrile infants (temperatures ≥38.0°C/100.4°F) ≤60 days of age who were being evaluated with blood cultures in 26 Pediatric Emergency Care Applied Research Network emergency departments between 2008 and 2013. Patients were divided into younger (0-28 days of age) and older (29-60 days of age) cohorts for analysis. We evaluated diagnostic testing and hospitalization rates by infant age group using chi-square tests and by site using analysis of variance.

RESULTS:

Four thousand seven hundred seventy-eight patients were eligible for analysis, of whom 1517 (32%) were 0-28 days of age. Rates of lumbar puncture and hospitalization were high (>90%) among infants ≤28 days of age, with chest radiography (35.5%) and viral testing (66.2%) less commonly obtained. Among infants 29-60 days of age, lumbar puncture (69.5%) and hospitalization (64.4%) rates were lower and declined with increasing age, with chest radiography (36.5%) use unchanged and viral testing (52.7%) slightly decreased. There was substantial variation between sites in the older cohort of infants, with lumbar puncture and hospitalization rates ranging from 40% to 90%.

CONCLUSIONS:

The evaluation and disposition of febrile infants ≤60 days of age is highly variable, particularly among infants who are 29-60 days of age. This variation demonstrates an opportunity to modify diagnostic and management strategies based on current epidemiology to safely decrease invasive testing and hospitalization.

KEYWORDS:

fever; guidelines infant; infectious disease; practice variation

PMID:
31014970
PMCID:
PMC6589384
[Available on 2020-06-01]
DOI:
10.1016/j.jemermed.2019.03.003

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