TY - JOUR
T1 - Variation in care of the febrile young infant,90 days in us pediatric emergency departments
AU - Aronson, Paul L.
AU - Thurm, Cary
AU - Alpern, Elizabeth R.
AU - Alessandrini, Evaline A.
AU - Williams, Derek J.
AU - Shah, Samir S.
AU - Nigrovic, Lise E.
AU - Mcculloh, Russell J.
AU - Schondelmeyer, Amanda
AU - Tieder, Joel S.
AU - Neuman, Mark I.
PY - 2014
Y1 - 2014
N2 - BACKGROUND AND OBJECTIVES: Variation in patient care or outcomes may indicate an opportunity to improve quality of care. We evaluated the variation in testing, treatment, hospitalization rates, and outcomes of febrile young infants in US pediatric emergency departments (EDs). METHODS: Retrospective cohort study of infants <90 days of age with a diagnosis code of fever who were evaluated in 1 of 37 pediatric EDs between July 1, 2011 and June 30, 2013. We assessed patient-And hospital-level variation in testing, treatment, and disposition for patients in 3 distinct age groups: ≤28, 29 to 56, and 57 to 89 days. We also compared interhospital variation for 3-day revisits and revisits resulting in hospitalization. RESULTS: We identified 35 070 ED visits that met inclusion criteria. The proportion of patients who underwent comprehensive evaluation, defined as urine, serum, and cerebrospinal fluid testing, decreased with increasing patient age: 72.0% (95% confidence interval [CI], 71.0-73.0) of neonates ≤28 days, 49.0% (95% CI, 48.2-49.8) of infants 29 to 56 days, and 13.1% (95% CI, 12.5-13.6) of infants 57 to 89 days. Significant interhospital variation was demonstrated in testing, treatment, and hospitalization rates overall and across all 3 age groups, with little interhospital variation in outcomes. Hospitalization rate in the overall cohort did not correlate with 3-day revisits (R2 = 0.10, P = .06) or revisits resulting in hospitalization (R2 = 0.08, P = .09). CONCLUSIONS: Substantial patient-And hospital-level variation was observed in the ED management of the febrile young infant, without concomitant differences in outcomes. Strategies to understand and address the modifiable sources of variation are needed.
AB - BACKGROUND AND OBJECTIVES: Variation in patient care or outcomes may indicate an opportunity to improve quality of care. We evaluated the variation in testing, treatment, hospitalization rates, and outcomes of febrile young infants in US pediatric emergency departments (EDs). METHODS: Retrospective cohort study of infants <90 days of age with a diagnosis code of fever who were evaluated in 1 of 37 pediatric EDs between July 1, 2011 and June 30, 2013. We assessed patient-And hospital-level variation in testing, treatment, and disposition for patients in 3 distinct age groups: ≤28, 29 to 56, and 57 to 89 days. We also compared interhospital variation for 3-day revisits and revisits resulting in hospitalization. RESULTS: We identified 35 070 ED visits that met inclusion criteria. The proportion of patients who underwent comprehensive evaluation, defined as urine, serum, and cerebrospinal fluid testing, decreased with increasing patient age: 72.0% (95% confidence interval [CI], 71.0-73.0) of neonates ≤28 days, 49.0% (95% CI, 48.2-49.8) of infants 29 to 56 days, and 13.1% (95% CI, 12.5-13.6) of infants 57 to 89 days. Significant interhospital variation was demonstrated in testing, treatment, and hospitalization rates overall and across all 3 age groups, with little interhospital variation in outcomes. Hospitalization rate in the overall cohort did not correlate with 3-day revisits (R2 = 0.10, P = .06) or revisits resulting in hospitalization (R2 = 0.08, P = .09). CONCLUSIONS: Substantial patient-And hospital-level variation was observed in the ED management of the febrile young infant, without concomitant differences in outcomes. Strategies to understand and address the modifiable sources of variation are needed.
KW - Febrile young infant
KW - Fever
KW - Low-risk criteria
KW - Neonatal sepsis
KW - Serious bacterial infection
KW - Variation
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UR - http://www.scopus.com/inward/citedby.url?scp=84925547376&partnerID=8YFLogxK
U2 - 10.1542/peds.2014-1382
DO - 10.1542/peds.2014-1382
M3 - Article
C2 - 25266437
AN - SCOPUS:84925547376
SN - 0031-4005
VL - 134
SP - 667
EP - 677
JO - Pediatrics
JF - Pediatrics
IS - 4
ER -