Charges and Complications Associated With the Medical Evaluation of Febrile Young Infants

Abstract

Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days. A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period after a retrospective pilot study. One investigator (C.C.) followed the medical course of enrolled FYIs, including 3 standardized scheduled phone follow-ups with the subject's parent and primary care provider (PCP) within the 2 weeks after discharge. Sixty-two subjects were enrolled during the 16-month period (58 admitted and 4 discharged subjects). Two (3%) subjects who met low-risk criteria developed a serious bacterial infection, both urinary tract infections. No cases of true bacteremia or bacterial meningitis were diagnosed. Seventeen subjects (29.3%) developed a complication during the admission. The mean length of inpatient stay was 49.0 hours (range, 18.1-65.4 hours). The mean charge for hospitalization was $6202 (range, $2818-$9880). Scheduled phone follow-up was successful on days 2 (77.4%), 7 (85.4%), and 14 (83.9%) after discharge. All patients were reported as improved (100%), and most parents preferred discharge to admission (66%-70%). In the 2 weeks after discharge, only 45 (72.6%) of 62 subjects had followed up with their PCPs. This prospective quality indicator/quality assurance study demonstrates that inpatient evaluation of low-risk FYIs results in high charges and potentially preventable complications. Hospitalization is contrary to the wishes of most parents in this study; however, the rate of appropriate follow-up with a PCP in this study is concerning.