Patient-Level Variation in the Management and Outcomes of Patients <90 d of Age With Diagnosis of Fever Across 37 Pediatric EDs
| Overall (n = 35 070), % (95% CI) | ≤28 days (n = 7712), % (95% CI) | 29–56 days (n = 15 033), % (95% CI) | 57–89 days (n = 12 325), % (95% CI) | Pa | |
|---|---|---|---|---|---|
| Testingb | |||||
| Laboratory Testingc | |||||
| Urine+Blood+CSF | 41.4 (40.9–41.9) | 72.0 (71.0–73.0) | 49.0 (48.2–49.8) | 13.1 (12.5–13.6) | < .001 |
| Urine+Blood | 27.6 (27.1–28.1) | 5.1 (4.6–5.6) | 27.3 (26.6–28.0) | 42.1 (41.2–43.0) | < .001 |
| Urine only | 6.0 (5.8–6.3) | 1.4 (1.1–1.6) | 3.2 (3.0–3.5) | 12.3 (11.7–12.9) | < .001 |
| Other combinations of Urine, Blood, CSF | 4.3 (4.1–4.5) | 3.6 (3.2–4.1) | 4.2 (3.9–4.6) | 4.9 (4.5–5.2) | .16 |
| None | 20.6 (20.2–21.0) | 17.9 (17.0–18.7) | 16.2 (15.6–16.8) | 27.7 (26.9–28.5) | < .001 |
| Radiographic Testing | |||||
| Chest radiograph | 27.8 (27.3–28.2) | 28.2 (27.2–29.2) | 29.0 (28.2–29.7) | 26.0 (25.3–26.8) | .58 |
| Treatmentb | |||||
| Hospitalizedd | (n = 14 678) | (n = 6035) | (n = 6628) | (n = 2015) | |
| Ampicillin+third generation cephalosporin | 45.9 (45.1–46.7) | 59.6 (58.3–60.8) | 43.1 (41.9–44.3) | 14.3 (12.8–15.9) | < .001 |
| Ampicillin+gentamicin | 10.6 (10.1–11.1) | 22.1 (21.0–23.1) | 3.2 (2.7–3.6) | 0.8 (0.4–1.2) | < .001 |
| Ampicillin+gentamicin+third generation cephalosporin | 5.7 (5.4–6.1) | 8.2 (7.5–8.9) | 4.5 (4.0–5.0) | 2.4 (1.7–3.0) | < .001 |
| Third generation cephalosporin alone | 18.9 (18.3–19.6) | 0.6 (0.4–0.8) | 28.4 (27.3–29.5) | 42.8 (40.6–44.9) | < .001 |
| Other IV or IM antibiotic combination | 7.9 (7.4–8.3) | 5.7 (5.1–6.2) | 8.5 (7.8–9.2) | 12.6 (11.1–14.0) | < .001 |
| No IV or IM antibiotics | 10.9 (10.4–11.4) | 3.9 (3.5–4.4) | 12.3 (11.5–13.1) | 27.1 (25.2–29.1) | < .001 |
| Acyclovir | 19.6 (18.9–20.2) | 32.3 (31.2–33.5) | 12.4 (11.6–13.1) | 5.0 (4.0–5.9) | < .001 |
| Discharged from the EDe | (n = 20 392) | (n = 1677) | (n = 8405) | (n = 10 310) | |
| Ceftriaxone | 15.6 (15.1–16.1) | 1.4 (0.9–2.0) | 20.3 (19.4–21.1) | 14.1 (13.4–14.8) | < .001 |
| Other IV or IM antibiotic | 0.7 (0.6–0.9) | 2.7 (1.9–3.5) | 1.0 (0.8–1.2) | 0.2 (0.1–0.3) | < .001 |
| No IV or IM antibiotics | 83.7 (83.2–84.2) | 95.9 (94.9–96.8) | 78.7 (77.9–79.6) | 85.7 (85.0–86.4) | < .001 |
| Disposition | |||||
| Hospitalized | 41.9 (41.3–42.4) | 78.3 (77.3–79.2) | 44.1 (43.3–44.9) | 16.3 (15.7–17.0) | <.001 |
| Outcomes | |||||
| SBIf | 8.4 (8.1–8.7) | 11.1 (10.4–11.8) | 7.5 (7.1–8.0) | 7.7 (7.2–8.2) | < .001 |
| 3-d revisitse | 6.0 (5.7–6.3) | 3.0 (2.5–3.4) | 6.6 (6.2–7.1) | 7.1 (6.5–7.6) | < .001 |
| 3-d revisits resulting in hospitalizatione | 2.0 (1.8–2.1) | 2.3 (1.9–2.7) | 2.3 (2.0–2.6) | 1.4 (1.2–1.6) | < .001 |
CXR, chest radiograph; IV, intravenous; IM, intramuscular.
↵a P value determined by Kruskal-Wallis 1-way analysis of variance
↵b Testing or treatment performed on Day 0 or 1 of hospitalization.
↵c Urine testing defined as urine dipstick, urinalysis or urine culture; blood testing as CBC or blood culture; CSF testing as cell count, culture, or lumbar puncture
↵d Percentage among hospitalized patients.
↵e Percentage among discharged patients.
↵f UTI or pyelonephritis, bacteremia or sepsis, bacterial meningitis, pneumonia, bacterial enteritis.