Dataset Information

Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age.

ABSTRACT:

Background

Differences among febrile infant institutional clinical practice guidelines (CPGs) may contribute to practice variation and increased healthcare costs.

Objective

Determine the association between pediatric emergency department (ED) CPGs and laboratory testing, hospitalization, ceftriaxone use, and costs in febrile infants.

Design

Retrospective cross-sectional study in 2013.

Setting

Thirty-three hospitals in the Pediatric Health Information System.

Patients

Infants aged ≤56 days with a diagnosis of fever.

Exposures

The presence and content of ED-based febrile infant CPGs assessed by electronic survey.

Measurements

Using generalized estimating equations, we evaluated the association between CPG recommendations and rates of urine, blood, cerebrospinal fluid (CSF) testing, hospitalization, and ceftriaxone use at ED discharge in 2 age groups: ≤28 days and 29 to 56 days. We also assessed CPG impact on healthcare costs.

Results

We included 9377 ED visits; 21 of 33 EDs (63.6%) had a CPG. For neonates ≤28 days, CPG recommendations did not vary and were not associated with differences in testing, hospitalization, or costs. Among infants 29 to 56 days, CPG recommendations for CSF testing and ceftriaxone use varied. CSF testing occurred less often at EDs with CPGs recommending limited testing compared to hospitals without CPGs (adjusted odds ratio: 0.5, 95% confidence interval: 0.3-0.8). Ceftriaxone use at ED discharge varied significantly based on CPG recommendations. Costs were higher for admitted and discharged infants 29 to 56 days old at hospitals with CPGs.

Conclusions

CPG recommendations for febrile infants 29 to 56 days old vary across institutions for CSF testing and ceftriaxone use, correlating with observed practice variation. CPGs were not associated with lower healthcare costs.

SUBMITTER: Aronson PL

PROVIDER: S-EPMC4456211 | biostudies-literature | 2015 Jun

REPOSITORIES: biostudies-literature

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Publications

Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age.

Aronson Paul L PL Thurm Cary C Williams Derek J DJ Nigrovic Lise E LE Alpern Elizabeth R ER Tieder Joel S JS Shah Samir S SS McCulloh Russell J RJ Balamuth Fran F Schondelmeyer Amanda C AC Alessandrini Evaline A EA Browning Whitney L WL Myers Angela L AL Neuman Mark I MI

Journal of hospital medicine 20150213 6

<h4>Background</h4>Differences among febrile infant institutional clinical practice guidelines (CPGs) may contribute to practice variation and increased healthcare costs.<h4>Objective</h4>Determine the association between pediatric emergency department (ED) CPGs and laboratory testing, hospitalization, ceftriaxone use, and costs in febrile infants.<h4>Design</h4>Retrospective cross-sectional study in 2013.<h4>Setting</h4>Thirty-three hospitals in the Pediatric Health Information System.<h4>Patie ...[more]

PMID: 25684689

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Project description:ObjectiveThe lack of evidence-based criteria to guide chest radiograph (CXR) use in young febrile infants results in variation in its use with resultant suboptimal quality of care. We sought to describe the features associated with radiographic pneumonias in young febrile infants.Study designSecondary analysis of a prospective cohort study in 18 emergency departments (EDs) in the Pediatric Emergency Care Applied Research Network from 2016 to 2019. Febrile (≥38°C) infants aged ≤60 days who received CXRs were included. CXR reports were categorised as 'no', 'possible' or 'definite' pneumonia. We compared demographics, clinical signs and laboratory tests among infants with and without pneumonias.ResultsOf 2612 infants, 568 (21.7%) had CXRs performed; 19 (3.3%) had definite and 34 (6%) had possible pneumonias. Patients with definite (4/19, 21.1%) or possible (11/34, 32.4%) pneumonias more frequently presented with respiratory distress compared with those without (77/515, 15.0%) pneumonias (adjusted OR 2.17; 95% CI 1.04 to 4.51). There were no differences in temperature or HR in infants with and without radiographic pneumonias. The median serum procalcitonin (PCT) level was higher in the definite (0.7 ng/mL (IQR 0.1, 1.5)) vs no pneumonia (0.1 ng/mL (IQR 0.1, 0.3)) groups, as was the median absolute neutrophil count (ANC) (definite, 5.8 K/mcL (IQR 3.9, 6.9) vs no pneumonia, 3.1 K/mcL (IQR 1.9, 5.3)). No infants with pneumonia had bacteraemia. Viral detection was frequent (no pneumonia (309/422, 73.2%), definite pneumonia (11/16, 68.8%), possible pneumonia (25/29, 86.2%)). Respiratory syncytial virus was the predominant pathogen in the pneumonia groups and rhinovirus in infants without pneumonias.ConclusionsRadiographic pneumonias were uncommon in febrile infants. Viral detection was common. Pneumonia was associated with respiratory distress, but few other factors. Although ANC and PCT levels were elevated in infants with definite pneumonias, further work is necessary to evaluate the role of blood biomarkers in infant pneumonias.

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Dataset Information

Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age.

Background

Objective

Design

Setting

Patients

Exposures

Measurements

Results

Conclusions

Publications

Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age.

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