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

Autor: Rogers AJ; Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI., Kuppermann N; Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, CA., Anders J; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD., Roosevelt G; Department of Emergency Medicine, Children's Hospital Colorado, Aurora, CO., Hoyle JD Jr; Department of Emergency Medicine, Western Michigan University, Kalamazoo, MI., Ruddy RM; Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, OH., Bennett JE; Department of Pediatrics, Nemours/AI Dupont Hospital for Children, Wilmington, DE., Borgialli DA; Department of Emergency Medicine, University of Michigan, Flint, MI., Dayan PS; Department of Pediatrics, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY., Powell EC; Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital, Chicago, IL., Casper TC; Department of Pediatrics, University of Utah; Salt Lake City, UT., Ramilo O; Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH., Mahajan P; Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI.
Jazyk: angličtina
Zdroj: The Journal of emergency medicine [J Emerg Med] 2019 Jun; Vol. 56 (6), pp. 583-591. Date of Electronic Publication: 2019 Apr 20.
DOI: 10.1016/j.jemermed.2019.03.003
Abstrakt: 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.
(Copyright © 2019 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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