Published online July 20, 2009
PEDIATRICS Vol. 124 No. 2 August 2009, pp. 439-445 (doi:10.1542/peds.2007-3736)

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ARTICLE

Practice Variations in the Treatment of Febrile Infants Among Pediatric Emergency Physicians

Ran D. Goldman, MD, MHRM, FRCPC^a,b,c, Dennis Scolnik, MD^d, Laurel Chauvin-Kimoff, MD^e, Ken J. Farion, MD, FRCPC^f, Samina Ali, MD^g, Tim Lynch, MD^h, Serge Gouin, MDⁱ, Martin H. Osmond, MD, CM, FRCPC^f, David W. Johnson, MD^j,k, Terry P. Klassen, MD, MSc^g for the Fever in Infants Group Research, Pediatric Emergency Research of Canada

^a Division of Pediatric Emergency Medicine, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, Canada
^b Department of Pediatrics, University of British Columbia, Vancouver, Canada
^c Child and Family Research Institute, Vancouver, Canada
^d Division of Pediatric Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
^e Division of Pediatric Emergency Medicine, Department of Pediatrics, McGill University and Montreal Children's Hospital, Montreal, Quebec, Canada
^f Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Ottawa and Children's Hospital of Eastern Ontario, Ottawa, Canada
^g Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta and Stollery Children's Hospital, Edmonton, Canada
^h Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Western Ontario and Children's Hospital of Western Ontario, London, Canada
ⁱ Division of Emergency Medicine, Department of Pediatrics, St Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada; Departments of
^j Pediatrics
^k Pharmacology and Therapeutics, University of Calgary, Calgary, Canada

OBJECTIVES: The objectives of this study were to characterize variations in treatment decisions for young febrile infants in pediatric emergency departments across Canada and to document the extent of practice variations among pediatric emergency department practitioners.

METHODS: This was a prospective, concurrent, cohort study of consecutive infants up to 90 days of age who presented to 6 pediatric emergency departments in Canada with fever (rectal temperature of 38.0°C). We recorded information in the emergency department and contacted the families by telephone to confirm the final disposition.

RESULTS: A total of 257 infants were recruited over 2 to 4 months. Patients were similar across centers in terms of gestational age and weight, chronologic age at arrival, weight, and gender. Temperatures measured at home and during triage and durations of fever also were similar among centers. In one center, significantly more children arrived with cough; in another center, fewer parents reported sick contacts at home. Rates of blood and urine testing were not significantly different across sites, but rates of lumbar puncture, respiratory virus testing, and chest radiography were different. A total of 55% of infants received antibiotics, and significant practice variations in the numbers and types of antibiotics used were documented.

CONCLUSIONS: Practices in the evaluation of young infants with fever in tertiary pediatric emergency departments varied substantially. Blood and urine tests were ordered in the majority of centers, but rates of cerebrospinal fluid testing and antibiotic treatment differed across centers.

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Key Words: fever • infants • practice variations • emergency department

Abbreviations: ED—emergency department • LP—lumbar puncture • PEM—pediatric emergency medicine

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Accepted Dec 16, 2008.

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