Clinical management and outcomes for febrile infants 29-60 days evaluated in community emergency departments.

Autor: Van Winkle PJ; Department of Pediatrics Kaiser Permanente Southern California, Anaheim Medical Center Anaheim California USA.; Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA., Lee SN; Undergraduate in Biological Sciences University of CA, Los Angeles Los Angeles California USA., Chen Q; Department of Research and Evaluation Southern California Permanente Medical Group Pasadena California USA., Baecker AS; Department of Research and Evaluation Southern California Permanente Medical Group Pasadena California USA., Ballard DW; Department of Emergency Medicine and the Division of Research The Permanente Medical Group, Kaiser Permanente Northern California Oakland California USA., Vinson DR; Department of Emergency Medicine and the Division of Research The Permanente Medical Group, Kaiser Permanente Northern California Oakland California USA., Greenhow TL; Department of Pediatric Infectious Diseases Kaiser Permanente Northern CA San Francisco California USA., Nguyen THP; Department of Inpatient Pediatrics Kaiser Permanente Northern CA Roseville California USA., Young BR; Department of Inpatient Pediatrics Kaiser Permanente Northern CA Roseville California USA., Alabaster AL; Division of Research Kaiser Permanente Northern California Oakland California USA., Huang J; Division of Research Kaiser Permanente Northern California Oakland California USA., Park S; Department of Research and Evaluation Southern California Permanente Medical Group Pasadena California USA., Sharp AL; Department of Clinical Science Kaiser Permanente Bernard J. Tyson School of Medicine Pasadena California USA.; Department of Research and Evaluation Southern California Permanente Medical Group Pasadena California USA.; Department of Emergency Medicine Kaiser Permanente Southern California, Los Angeles Medical Center Los Angeles California USA.
Jazyk: angličtina
Zdroj: Journal of the American College of Emergency Physicians open [J Am Coll Emerg Physicians Open] 2022 Jun 17; Vol. 3 (3), pp. e12754. Date of Electronic Publication: 2022 Jun 17 (Print Publication: 2022).
DOI: 10.1002/emp2.12754
Abstrakt: Objective: Describe emergency department (ED) management and patient outcomes for febrile infants 29-60 days of age who received a lumbar puncture (LP), with focus on timing of antibiotics and type of physician performing LP.
Methods: Retrospective observational study of 35 California EDs from January 1, 2010 through December 31, 2019. Primary analysis was among patients with successful LP and primary outcome was hospital length of stay (LOS). Logistic regression analysis included variables associated with LOS of at least 2 days. Secondary outcomes were bacterial meningitis, hospital admission, length of antibiotics, and readmission.
Results: Among 2569 febrile infants (median age 39 days), 667 underwent successful LP and 633 received intravenous antibiotics. Most infants ( n  = 559, 88.3%) had their LP before intravenous antibiotic administration. Pediatricians performed 54% of LPs and emergency physicians 34%. Sixteen infants (0.6% of 2569) were diagnosed with bacterial meningitis, and none died. Five hundred and fifty-eight (88%) infants receiving an LP were hospitalized. Among patients receiving an LP and antibiotics ( n  = 633), 6.5% were readmitted within 30 days. Patients receiving antibiotics before LP had a longer length of antibiotics (+ 7.9 hours, 95% confidence interval [CI] 3.8-13.4). Primary analysis found no association between timing of antibiotics and LOS (odds ratio [OR] 0.67, 95% CI 0.34-1.30), but shorter LOS when emergency physicians performed the LP (OR 0.66, 95% CI 0.45-0.97).
Conclusions: Febrile infants in the ED had no deaths and few cases of bacterial meningitis. In community EDs, where a pediatrician is often not available, successful LP by emergency physician was associated with reduced inpatient LOS.
Competing Interests: There are no conflicts of interest. None of the authors have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) their work.
(© 2022 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)
Databáze: MEDLINE
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