Variation in care of the febrile young infant,90 days in us pediatric emergency departments

Paul L. Aronson, Cary Thurm, Elizabeth R. Alpern, Evaline A. Alessandrini, Derek J. Williams, Samir S. Shah, Lise E. Nigrovic, Russell J. Mcculloh, Amanda Schondelmeyer, Joel S. Tieder, Mark I. Neuman

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)667-677
Number of pages11
JournalPediatrics
Volume134
Issue number4
DOIs
StatePublished - Jan 1 2014

Fingerprint

Hospital Emergency Service
Hospitalization
Fever
Pediatrics
Confidence Intervals
Age Groups
Quality of Health Care
Cerebrospinal Fluid
Patient Care
Cohort Studies
Therapeutics
Retrospective Studies
Urine
Newborn Infant
Serum

Keywords

  • Febrile young infant
  • Febrile young infant
  • Fever
  • Fever
  • Low-risk criteria
  • Low-risk criteria
  • Neonatal sepsis
  • Neonatal sepsis
  • Serious bacterial infection
  • Serious bacterial infection
  • Variation
  • Variation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Aronson, P. L., Thurm, C., Alpern, E. R., Alessandrini, E. A., Williams, D. J., Shah, S. S., ... Neuman, M. I. (2014). Variation in care of the febrile young infant,90 days in us pediatric emergency departments. Pediatrics, 134(4), 667-677. https://doi.org/10.1542/peds.2014-1382

Variation in care of the febrile young infant,90 days in us pediatric emergency departments. / Aronson, Paul L.; Thurm, Cary; Alpern, Elizabeth R.; Alessandrini, Evaline A.; Williams, Derek J.; Shah, Samir S.; Nigrovic, Lise E.; Mcculloh, Russell J.; Schondelmeyer, Amanda; Tieder, Joel S.; Neuman, Mark I.

In: Pediatrics, Vol. 134, No. 4, 01.01.2014, p. 667-677.

Research output: Contribution to journalArticle

Aronson, PL, Thurm, C, Alpern, ER, Alessandrini, EA, Williams, DJ, Shah, SS, Nigrovic, LE, Mcculloh, RJ, Schondelmeyer, A, Tieder, JS & Neuman, MI 2014, 'Variation in care of the febrile young infant,90 days in us pediatric emergency departments', Pediatrics, vol. 134, no. 4, pp. 667-677. https://doi.org/10.1542/peds.2014-1382
Aronson PL, Thurm C, Alpern ER, Alessandrini EA, Williams DJ, Shah SS et al. Variation in care of the febrile young infant,90 days in us pediatric emergency departments. Pediatrics. 2014 Jan 1;134(4):667-677. https://doi.org/10.1542/peds.2014-1382
Aronson, Paul L. ; Thurm, Cary ; Alpern, Elizabeth R. ; Alessandrini, Evaline A. ; Williams, Derek J. ; Shah, Samir S. ; Nigrovic, Lise E. ; Mcculloh, Russell J. ; Schondelmeyer, Amanda ; Tieder, Joel S. ; Neuman, Mark I. / Variation in care of the febrile young infant,90 days in us pediatric emergency departments. In: Pediatrics. 2014 ; Vol. 134, No. 4. pp. 667-677.
@article{fa166f9a990241aabcad9bca2bb7f98a,
title = "Variation in care of the febrile young infant,90 days in us pediatric emergency departments",
abstract = "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.",
keywords = "Febrile young infant, Febrile young infant, Fever, Fever, Low-risk criteria, Low-risk criteria, Neonatal sepsis, Neonatal sepsis, Serious bacterial infection, Serious bacterial infection, Variation, Variation",
author = "Aronson, {Paul L.} and Cary Thurm and Alpern, {Elizabeth R.} and Alessandrini, {Evaline A.} and Williams, {Derek J.} and Shah, {Samir S.} and Nigrovic, {Lise E.} and Mcculloh, {Russell J.} and Amanda Schondelmeyer and Tieder, {Joel S.} and Neuman, {Mark I.}",
year = "2014",
month = "1",
day = "1",
doi = "10.1542/peds.2014-1382",
language = "English (US)",
volume = "134",
pages = "667--677",
journal = "Pediatrics",
issn = "0031-4005",
publisher = "American Academy of Pediatrics",
number = "4",

}

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 - 2014/1/1

Y1 - 2014/1/1

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 - Febrile young infant

KW - Fever

KW - Fever

KW - Low-risk criteria

KW - Low-risk criteria

KW - Neonatal sepsis

KW - Neonatal sepsis

KW - Serious bacterial infection

KW - Serious bacterial infection

KW - Variation

KW - Variation

UR - http://www.scopus.com/inward/record.url?scp=84925547376&partnerID=8YFLogxK

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

VL - 134

SP - 667

EP - 677

JO - Pediatrics

JF - Pediatrics

SN - 0031-4005

IS - 4

ER -