Management of febrile infants and children by pediatric emergency medicine and emergency medicine: Comparison with practice guidelines

Belfer, Robert A.; Gittelman, Michael A.; Muñiz, Antonio E.

doi:10.1097/00006565-200104000-00001

Cited by 57 publications

(38 citation statements)

References 16 publications

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“…Several studies have been published, however, that examine differences between pediatric and general emergency departments in the management of bronchiolitis and, as well, several other diseases. [47][48][49][50][51][52][53] Although several studies used surveys to assess opinions regarding various management strategies, [47][48][49] some also used a retrospective methodology to establish actual differences in practice patterns between pediatric and general emergency physicians. 50 -53 In general, retrospective studies are thought to provide poorer quality data than that obtained from a prospective study design.…”

Section: Discussionmentioning

confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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ABSTRACT. Objective. It is uncertain whether pediatric and general emergency departments have different admitting practices regarding children with bronchiolitis. The objective of this study was to quantify the differences in admission practices between pediatric and general emergency departments of children with bronchiolitis in 1 North American metropolitan area, controlling for various factors such as clinical severity, comorbid conditions, and socioeconomic status.Design. Retrospective cohort review of emergency department visits from April 1992 to March 1997.Setting. Five emergency departments (1 pediatric and 4 general) serving the Calgary Health Region, which encompasses ϳ850 000 people.Patients. All children residing within the region who visited a regional emergency department and were diagnosed to have bronchiolitis (International Classification of Diseases, Ninth Revision code 466.1, primary or secondary diagnosis).Main Outcome Measure. Population-standardized estimates of admission rates.Results. The medical charts of 3091 children diagnosed to have bronchiolitis during the study period were reviewed. Of this number, 2496 children were evaluated at the pediatric emergency department, and 629 (25%) were admitted. The remaining 595 (19%) were evaluated at the general emergency departments, and 221 (37%) were admitted. Controlling for age, gender, estimated family income based on postal code, medical comorbidity, and clinical severity estimated by presenting respiratory rate and room air oxygen saturation, populationstandardized estimates for admission rates at the pediatric and general emergency departments were 24% (standard error: 1%) and 43% (standard error: 2%), respectively.Conclusion. Children diagnosed to have bronchiolitis at the Calgary Health Region's pediatric emergency department were about half as likely to be admitted to the hospital as children diagnosed at the region's general emergency departments. Pediatrics 2002;110(4). URL: http://www.pediatrics.org/cgi/content/full/110/4/e49; bronchiolitis, hospitalization rates, practice variation, emergency department. ABBREVIATIONS. CHR, Calgary Health Region; International Classification of Diseases, Ninth Revision; CI, confidence interval. B ronchiolitis is an extremely common childhood disease that accounts for a significant proportion of pediatric hospitalizations. 1 Investigators, using the technique of small-area analysis, have found marked variations in hospitalization rates of children with bronchiolitis with reports of up to sixfold differences in rates per 100 000 children. [2][3][4] This degree of variation is not unique to bronchiolitis, in that substantial variations in rates have been documented for a number of surgical procedures and diseases. 5,6 Although controversy exists as to which factors, in general, are most responsible for the variability in medical practices, in most cases differences in health care access and socioeconomic factors account for at least some proportion of the variability. 5,6 Likewise, in the case of b...

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Section: Discussionmentioning

confidence: 99%

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

et al. 2002

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“…O documento estratifica as crianças por faixa etária e, ainda, pelo risco para IBG (baixo e alto), através de crité-rios clínicos e laboratoriais. A partir dele, várias estratégias foram elaboradas no intuito de padronizar a abordagem das crianças com FSSL 1,2,4,[15][16][17] .…”

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Fever without source: evaluation of a guideline

Machado¹,

Cardoso²,

Paulis³

et al. 2009

J Pediatr (Rio J)

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Objective: To evaluate the applicability of a standardized guideline for children up to 36 months of age with fever without source (FWS). Methods:Prospective cohort study involving children with FWS treated at the emergency department of Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil, from June 2006 to May 2007. The guideline classifies the risk of serious bacterial infection (SBI) according to the presence or absence of toxemia, age, and temperature. Laboratory screening was based on risk assessment: complete blood count, blood culture, urinalysis, urine culture, and, if necessary, chest radiography, cerebrospinal fluid, and coproculture. Results:We studied 251 children and, of these, 215 were followed up until the final diagnosis. Toxemia was found in 20 children, and 195 were well-appearing (30 up to 3 months old and 165 from 3 to 36 months old). Among those children from 3 to 36 months without toxemia, 95 had axillary temperature > 39 ºC. In 107 (49.8%) children, there was spontaneous resolution of fever; in 88 (40.9%), benign self-limited disease was identified; and in 20 (9.3%), there was SBI. Among the cases of SBI, we identified 16 urinary tract infections, three cases of pneumonia and one occult bacteremia. Of the 215 children, 129 (60%) received no antibiotics, and 86 received antibiotics at some point (45 empirically). Empirical antibiotic treatment was maintained for an average of 72 hours. Conclusion:The guideline was shown to be appropriate to follow up these children using simple laboratory tests that can be carried out at most health facilities. The most frequent SBI in this sample was urinary tract infection. J Pediatr (Rio J)

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“…12 Studies on variation and adherence to existing practice guidelines for evaluation and management of fever in young infants have been limited to surveys or adherence to recommended urine testing or have excluded neonates 0-28 days of age. [13][14][15] Belfer et al 16 conducted a survey-based study on compliance with guidelines for the management of febrile infants and found 54% compliance among pediatric emergency medicine directors. To our knowledge, no large multi-institutional study has reported actual practice for the management of febrile neonates in terms of variation and adherence to standard recommendations in pediatric emergency departments (PEDs) in the United States.…”

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confidence: 99%

Management of Febrile Neonates in US Pediatric Emergency Departments

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Recommended management of febrile neonates (#28 days) includes blood, urine, and cerebrospinal fluid cultures with hospital admission for antibiotic therapy. No study has reported adherence to standard recommendations in the management of febrile neonates in US pediatric emergency departments. WHAT THIS STUDY ADDS:There is wide variation in adherence to recommended management of febrile neonates. High rates of serious infections in admitted patients but low return rates for missed infections in discharged patients suggest additional studies needed to understand variation from current recommendations. abstract BACKGROUND: Blood, urine, and cerebrospinal fluid cultures and admission for antibiotics are considered standard management of febrile neonates (0-28 days). We examined variation in adherence to these recommendations across US pediatric emergency departments (PEDs) and incidence of serious infections (SIs) in febrile neonates. METHODS:Cross-sectional study of neonates with a diagnosis of fever evaluated in 36 PEDs in the 2010 Pediatric Health Information System database. We analyzed performance of recommended management (laboratory testing, antibiotic use, admission to hospital), 48-hour return visits to PED, and diagnoses of SI. RESULTS:Of 2253 neonates meeting study criteria, 369 (16.4%) were evaluated and discharged from the PED; 1884 (83.6%) were admitted. Recommended management occurred in 1497 of 2253 (66.4%; 95% confidence interval, 64.5-68.4) febrile neonates. There was more than twofold variation across the 36 PEDs in adherence to recommended management, recommended testing, and recommended treatment of febrile neonates. There was significant variation in testing and treatment between admitted and discharged neonates (P , .001). A total of 269 in 2253 (11.9%) neonates had SI, of whom 223 (82.9%; 95% confidence interval, 77.9-86.9) received recommended management.CONCLUSIONS: There was wide variation across US PEDs in adherence to recommended management of febrile neonates. One in 6 febrile neonates was discharged from the PED; discharged patients were less likely to receive testing or antibiotic therapy than admitted patients. A majority of neonates with SI received recommended evaluation and management. High rates of SI in admitted patients but low return rates for missed infections in discharged patients suggest a need for additional studies to understand variation from the current recommendations.

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Management of febrile infants and children by pediatric emergency medicine and emergency medicine: Comparison with practice guidelines

Abstract: There is poor compliance with published practice guidelines in the management of febrile infants and children among PEM and EM directors.

Cited by 57 publications

References 16 publications

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

Differences in Admission Rates of Children With Bronchiolitis by Pediatric and General Emergency Departments

Fever without source: evaluation of a guideline

Management of Febrile Neonates in US Pediatric Emergency Departments

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