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

Abstract

Febrile infants commonly present to emergency departments for evaluation. We describe the variation in diagnostic testing and hospitalization of febrile infants ≤60days of age presenting to the emergency departments in the Pediatric Emergency Care Applied Research Network. We enrolled a convenience sample of non-critically ill-appearing febrile infants (temperatures ≥38.0°C/100.4°F) ≤60days 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 (0-28days of age) and older (29-60days of age) cohorts for analysis. We evaluated diagnostic testing and hospitalization rates by infant agegroup using chi-square tests and by site using analysis of variance. Four thousand seven hundred seventy-eight patients were eligible for analysis, of whom 1517 (32%) were 0-28days of age. Rates of lumbar puncture and hospitalization were high (>90%) among infants ≤28days of age, with chest radiography (35.5%) and viral testing (66.2%) less commonly obtained. Among infants 29-60days 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%. The evaluation and disposition of febrile infants ≤60days of age is highly variable, particularly among infants who are 29-60days of age. This variation demonstrates an opportunity to modify diagnostic and management strategies based on current epidemiology to safely decrease invasive testing and hospitalization.