The Management of Febrile Infants by Primary-Care Pediatricians in Utah: Comparison With Published Practice Guidelines

¹ Department of Pediatrics, The University of Utah School of Medicine, Salt Lake City, UT

Objective. To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines.

Design. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies.

Results. Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40°C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants.

Conclusion. Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.

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