Original Research

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

Corresponding Author

Paul L. Aronson MD

Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut

Address for correspondence and reprint requests: Paul L. Aronson, MD, Section of Pediatric Emergency Medicine, Yale School of Medicine, 100 York Street, Suite 1F, New Haven, CT 06511; Telephone: 203–737-7443; Fax: 203–737-7447; E-mail: [email protected]Search for more papers by this author

Cary Thurm PhD,

Cary Thurm PhD

Children's Hospital Association, Overland Park, Kansas

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Derek J. Williams MD, MPH,

Derek J. Williams MD, MPH

Division of Hospital Medicine, Department of Pediatrics, The Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee

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Lise E. Nigrovic MD, MPH,

Lise E. Nigrovic MD, MPH

Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

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Elizabeth R. Alpern MD, MSCE,

Elizabeth R. Alpern MD, MSCE

Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Joel S. Tieder MD, MPH,

Joel S. Tieder MD, MPH

Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington

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Samir S. Shah MD, MSCE,

Samir S. Shah MD, MSCE

Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

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Russell J. McCulloh MD,

Russell J. McCulloh MD

Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri

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Fran Balamuth MD, PhD, MSCE,

Fran Balamuth MD, PhD, MSCE

The Center for Pediatric Clinical Effectiveness and Division of Emergency Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania

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Amanda C. Schondelmeyer MD,

Amanda C. Schondelmeyer MD

Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

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Evaline A. Alessandrini MD, MSCE,

Evaline A. Alessandrini MD, MSCE

James M. Anderson Center for Health Systems Excellence and Division of Emergency Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

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Whitney L. Browning MD,

Whitney L. Browning MD

Division of Hospital Medicine, Department of Pediatrics, The Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee

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Angela L. Myers MD, MPH,

Angela L. Myers MD, MPH

Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri

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Mark I. Neuman MD, MPH,

Mark I. Neuman MD, MPH

Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

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for the Febrile Young Infant Research Collaborative,

for the Febrile Young Infant Research Collaborative

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Paul L. Aronson MD,

Corresponding Author

Paul L. Aronson MD

Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut

Cary Thurm PhD,

Cary Thurm PhD

Children's Hospital Association, Overland Park, Kansas

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Derek J. Williams MD, MPH,

Derek J. Williams MD, MPH

Division of Hospital Medicine, Department of Pediatrics, The Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee

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Lise E. Nigrovic MD, MPH,

Lise E. Nigrovic MD, MPH

Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

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Elizabeth R. Alpern MD, MSCE,

Elizabeth R. Alpern MD, MSCE

Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois

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Joel S. Tieder MD, MPH,

Joel S. Tieder MD, MPH

Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington

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Samir S. Shah MD, MSCE,

Samir S. Shah MD, MSCE

Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

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Russell J. McCulloh MD,

Russell J. McCulloh MD

Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri

Search for more papers by this author

Fran Balamuth MD, PhD, MSCE,

Fran Balamuth MD, PhD, MSCE

Search for more papers by this author

Amanda C. Schondelmeyer MD,

Amanda C. Schondelmeyer MD

Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio

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Evaline A. Alessandrini MD, MSCE,

Evaline A. Alessandrini MD, MSCE

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Whitney L. Browning MD,

Whitney L. Browning MD

Division of Hospital Medicine, Department of Pediatrics, The Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee

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Angela L. Myers MD, MPH,

Angela L. Myers MD, MPH

Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospital, University of Missouri–Kansas City School of Medicine, Kansas City, Missouri

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Mark I. Neuman MD, MPH,

Mark I. Neuman MD, MPH

Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts

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for the Febrile Young Infant Research Collaborative,

for the Febrile Young Infant Research Collaborative

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First published: 13 February 2015

https://doi.org/10.1002/jhm.2329

Citations: 56

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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. Journal of Hospital Medicine 2015;10:358–365. © 2015 Society of Hospital Medicine

Supporting Information

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Citing Literature

Volume10, Issue6

June 2015

Pages 358-365

Filename	Description
jhm2329-sup-0001-suppinfo01.doc86.5 KB	Supplementary Information Author Contribution
jhm2329-sup-0001-suppinfotbl01.doc51.5 KB	Supplementary Information Table 1
jhm2329-sup-0001-suppinfotbl02.doc61.5 KB	Supplementary Information Table 2

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

Abstract

BACKGROUND

OBJECTIVE

DESIGN

SETTING

PATIENTS

EXPOSURES

MEASUREMENTS

RESULTS

CONCLUSIONS

Supporting Information

References

Citing Literature

References

Information

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

Abstract

BACKGROUND

OBJECTIVE

DESIGN

SETTING

PATIENTS

EXPOSURES

MEASUREMENTS

RESULTS

CONCLUSIONS

Supporting Information

References

Citing Literature

References

Related

Information