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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
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]