TABLE 2

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+CSF41.4 (40.9–41.9)72.0 (71.0–73.0)49.0 (48.2–49.8)13.1 (12.5–13.6)< .001
  Urine+Blood27.6 (27.1–28.1)5.1 (4.6–5.6)27.3 (26.6–28.0)42.1 (41.2–43.0)< .001
  Urine only6.0 (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, CSF4.3 (4.1–4.5)3.6 (3.2–4.1)4.2 (3.9–4.6)4.9 (4.5–5.2).16
  None20.6 (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 radiograph27.8 (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 cephalosporin45.9 (45.1–46.7)59.6 (58.3–60.8)43.1 (41.9–44.3)14.3 (12.8–15.9)< .001
  Ampicillin+gentamicin10.6 (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 cephalosporin5.7 (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 alone18.9 (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 combination7.9 (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 antibiotics10.9 (10.4–11.4)3.9 (3.5–4.4)12.3 (11.5–13.1)27.1 (25.2–29.1)< .001
  Acyclovir19.6 (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)
  Ceftriaxone15.6 (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 antibiotic0.7 (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 antibiotics83.7 (83.2–84.2)95.9 (94.9–96.8)78.7 (77.9–79.6)85.7 (85.0–86.4)< .001
Disposition
 Hospitalized41.9 (41.3–42.4)78.3 (77.3–79.2)44.1 (43.3–44.9)16.3 (15.7–17.0)<.001
Outcomes
 SBIf8.4 (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 revisitse6.0 (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 hospitalizatione2.0 (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.