Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age
Open accessAbstract
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
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When a clinical practice guideline is adopted by an institution, more uniform care is provided to febrile infants, which can result in more appropriate use of diagnostic tests, antibiotics, hospitalization, and lower health care costs.
“However, when a clinical practice guideline (CPG) is adopted by an institution there is more uniform care provided to febrile infants,24 which can result in more appropriate use of diagnostic tests, antibiotics, hospitalization,25 and lower health care costs.26”
From Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload (2019) · cites this paper as [24]
There is wide variation in the evaluation of febrile infants for suspected SBI across hospitals, emergency departments, and ambulatory settings.
“There is wide variation in the evaluation of febrile infants for suspected SBI across hospitals, emergency departments, and ambulatory settings.24”
From Impact of Mobile Device-Based Clinical Decision Support Tool on Guideline Adherence and Mental Workload (2019) · cites this paper as [24]
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- Authors
- Aronson, P. L., Thurm, C., Williams, D. J., Nigrovic, L. E., Alpern, E. R., Tieder, J. S., Shah, S. S., McCulloh, R. J., Balamuth, F., Schondelmeyer, A. C., Alessandrini, E. A., Browning, W. L., Myers, A. L., Neuman, M. I., & Collaborative, F. T. F. Y. I. R.
- Affiliations
- Yale University (US)
- Children's Hospital Association (US)
- Monroe Carell Jr. Children's Hospital (US)
- Boston Children's Hospital (US)
- Northwestern University (US)
- Seattle Children's Hospital (US)
- Cincinnati Children's Hospital Medical Center (US)
- Children's Mercy Hospital (US)
- Children's Hospital of Philadelphia (US)
- Corresponding author
- Aronson, Paul L.
- ORCID
- Venue
- Journal of Hospital Medicine
- Publisher
- Wiley
- Published
- 2015-02-13
- Volume
- 10
- Issue
- 6
- Pages
- 358-365
- ISSN
- 1553-5592 (ISSN-L)
- 1553-5606
- PMC
- PMC4456211
- OpenAlex
- W1732267889
- Cited by
- 75
- References
- 31
- Citations by year
- 2026: 2 · 2025: 7 · 2024: 5 · 2023: 3 · 2022: 10 · 2021: 3 · 2020: 9 · 2019: 8 · 2018: 12 · 2017: 8 · 2016: 4 · 2015: 3
- FWCI
- 9.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Hospital Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Gerber Foundation (1827-3835)
- National Institutes of Health (NHLBI K12-HL109009)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Urology and Nephrology Studies
- Keywords
- febrile infants, pediatric emergency department, cerebrospinal fluid analysis, ceftriaxone, health care costs, clinical practice variation, neonatal fever, laboratory testing, hospitalization
- MeSH terms
- Anti-Bacterial Agents, Blood Chemical Analysis, Ceftriaxone, Cerebrospinal Fluid, Cost Control, Cross-Sectional Studies, Emergency Service, Hospital, Fever, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Retrospective Studies, United States, Urinalysis, Practice Guidelines as Topic, Health Care Surveys, Guideline Adherence, Health Information Systems
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