TY - JOUR
T1 - Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days
AU - Febrile Young Infant Research Collaborative
AU - Chua, Kao Ping
AU - Neuman, Mark I.
AU - McWilliams, J. Michael
AU - Aronson, Paul L.
AU - Thurm, Cary
AU - Williams, Derek J.
AU - Browning, Whitney L.
AU - Nigrovic, Lise E.
AU - Alpern, Elizabeth R.
AU - Tieder, Joel S.
AU - Feldman, Elana A.
AU - Shah, Samir S.
AU - Schondelmeyer, Amanda C.
AU - Alessandrini, Evaline A.
AU - McCulloh, Russell J.
AU - Myers, Angela L.
AU - Balamuth, Fran
AU - Hayes, Katie L.
N1 - Funding Information:
We would like to thank the following individuals for their helpful comments and technical assistance: Katherine Swartz, PhD (Harvard School of Public Health), Benjamin Sommers, MD, PhD (Harvard School of Public Health), Simo Goshev, PhD (Harvard University), and Aaron Schwartz, PhD (Harvard Medical School). The authors also acknowledge the work of the Febrile Young Infant Research Collaborative in collecting data for the CPG survey.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2020
Y1 - 2020
N2 - Objective: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days. Study design: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year. Results: The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI −0.18 to 0.85; P =. 22). Conclusions: Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.
AB - Objective: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days. Study design: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year. Results: The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI −0.18 to 0.85; P =. 22). Conclusions: Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.
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U2 - 10.1016/j.jpeds.2015.09.021
DO - 10.1016/j.jpeds.2015.09.021
M3 - Article
C2 - 26477870
AN - SCOPUS:85019794134
SN - 0022-3476
SP - 1340-1346.e9
JO - journal of pediatrics
JF - journal of pediatrics
ER -