Practice Variation in the Evaluation and Disposition of Febrile Infants ≤60 Days of Age.
Biomarkers
/ analysis
Cohort Studies
Critical Illness
/ epidemiology
Diagnostic Tests, Routine
/ methods
Emergency Service, Hospital
/ organization & administration
Female
Fever
/ diagnosis
Hospitalization
/ statistics & numerical data
Humans
Infant
Infant, Newborn
Male
Practice Patterns, Physicians'
/ standards
Prospective Studies
fever
guidelines infant
infectious disease
practice variation
Journal
The Journal of emergency medicine
ISSN: 0736-4679
Titre abrégé: J Emerg Med
Pays: United States
ID NLM: 8412174
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
29
11
2018
revised:
08
02
2019
accepted:
04
03
2019
pubmed:
25
4
2019
medline:
31
3
2020
entrez:
25
4
2019
Statut:
ppublish
Résumé
Febrile infants commonly present to emergency departments for evaluation. 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. 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. 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%. 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.
Sections du résumé
BACKGROUND
BACKGROUND
Febrile infants commonly present to emergency departments for evaluation.
OBJECTIVE
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
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
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
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.
Identifiants
pubmed: 31014970
pii: S0736-4679(19)30129-5
doi: 10.1016/j.jemermed.2019.03.003
pmc: PMC6589384
mid: NIHMS1523766
pii:
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
583-591Subventions
Organisme : NICHD NIH HHS
ID : R01 HD062477
Pays : United States
Organisme : NICHD NIH HHS
ID : R01 HD085233
Pays : United States
Informations de copyright
Copyright © 2019 Elsevier Inc. All rights reserved.
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