 |
|
Management and Outcomes of Care of Fever in Early Infancy
Robert H. Pantell, MD;
Thomas B. Newman, MD, MPH;
Jane Bernzweig, PhD;
David A. Bergman, MD;
John I. Takayama, MD, MPH;
Mark Segal, PhD;
Stacia A. Finch, MA;
Richard C. Wasserman, MD, MPH
JAMA. 2004;291:1203-1212.
Context Fever in infants challenges clinicians in distinguishing between serious conditions, such as bacteremia or bacterial meningitis, and minor illnesses. To date, the practice patterns of office-based pediatricians in treating febrile infants and the clinical outcomes resulting from their care have not been systematically studied.
Objectives To characterize the management and clinical outcomes of fever in infants, develop a clinical prediction model for the identification of bacteremia/bacterial meningitis, and compare the accuracy of various strategies.
Design Prospective cohort study.
Setting Offices of 573 practitioners from the Pediatric Research in Office Settings (PROS) network of the American Academy of Pediatrics in 44 states, the District of Columbia, and Puerto Rico.
Patients Consecutive sample of 3066 infants aged 3 months or younger with temperatures of at least 38°C seen by PROS practitioners from February 28, 1995, through April 25, 1998.
Main Outcome Measures Management strategies, illness frequency, and rates and accuracy of treating bacteremia/bacterial meningitis.
Results The PROS clinicians hospitalized 36% of the infants, performed laboratory testing in 75%, and initially treated 57% with antibiotics. The majority (64%) were treated exclusively outside of the hospital. Bacteremia was detected in 1.8% of infants (2.4% of those tested) and bacterial meningitis in 0.5%. Well-appearing infants aged 25 days or older with fever of less than 38.6°C had a rate of 0.4% for bacteremia/bacterial meningitis. Frequency of other illnesses included urinary tract infection, 5.4%; otitis media, 12.2%; upper respiratory tract infection, 25.6%; bronchiolitis, 7.8%; and gastroenteritis, 7.2%. Practitioners followed current guidelines in 42% of episodes. However, in the initial visit, they treated 61 of the 63 cases of bacteremia/bacterial meningitis with antibiotics. Neither current guidelines nor the model developed in this study performed with greater accuracy than observed practitioner management.
Conclusions Pediatric clinicians in the United States use individualized clinical judgment in treating febrile infants. In this study, relying on current clinical guidelines would not have improved care but would have resulted in more hospitalizations and laboratory testing.
Author Affiliations: Division of General Pediatrics, Department of Pediatrics (Drs Pantell, Newman, Bernzweig, and Takayama), and Department of Epidemiology and Biostatistics (Drs Newman and Segal), School of Medicine, University of California, San Francisco; Department of Pediatrics, Lucile Salter Packard Children's Hospital at Stanford Medical Center, Stanford, Calif (Dr Bergman); Pediatric Research in Office Settings (PROS), Department of Practice and Research, Center for Child Health Research, American Academy of Pediatrics, Elk Grove Village, Ill (Ms Finch and Dr Wasserman); and Department of Pediatrics, Vermont College of Medicine, Burlington (Dr Wasserman).
RELATED ARTICLES
Young, Febrile Infants: A 30-Year Odyssey Ends Where It Started
Kenneth B. Roberts
JAMA. 2004;291(10):1261-1262.
EXTRACT
| FULL TEXT
Fever in Infants
Janet M. Torpy, Cassio Lynm, and Richard M. Glass
JAMA. 2004;291(10):1284.
EXTRACT
| FULL TEXT
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
From Suspicion of Physical Child Abuse to Reporting: Primary Care Clinician Decision-Making
Flaherty et al.
Pediatrics 2008;122:611-619.
ABSTRACT
| FULL TEXT
Is there a place for "drive thru" management of neonatal fever? Not yet!
Rudd
Arch. Dis. Child. Fetal Neonatal Ed. 2007;92:F2-F3.
FULL TEXT
Does Clinical Presentation Explain Practice Variability in the Treatment of Febrile Infants?
Bergman et al.
Pediatrics 2006;117:787-795.
ABSTRACT
| FULL TEXT
Choice of Urine Collection Methods for the Diagnosis of Urinary Tract Infection in Young, Febrile Infants
Schroeder et al.
Arch Pediatr Adolesc Med 2005;159:915-922.
ABSTRACT
| FULL TEXT
Managing Febrile Infants: Impact of Literature Recommendations Published During a Physician's Residency
Cox et al.
Eval Health Prof 2005;28:328-348.
ABSTRACT
Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants
Zorc et al.
Pediatrics 2005;116:644-648.
ABSTRACT
| FULL TEXT
Pulse Oximetry May Unnecessarily Prolong Hospital Stay for Bronchiolitis
Schenkman
AAP Grand Rounds 2004;12:27-27.
FULL TEXT
Managing Febrile Infants: Clinical Guidelines Are No Better Than Clinical Judgment But More Expensive
Raszka
AAP Grand Rounds 2004;12:1-2.
FULL TEXT
Clinical judgment effective for detecting bacteremia
AAP News 2004;24:292-292.
FULL TEXT
Pediatricians' Approach to Fever in Infants
JWatch Emergency Med. 2004;2004:8-8.
FULL TEXT
Care of the Febrile Infant: How to Be a Pro
JWatch Pediatrics 2004;2004:1-1.
FULL TEXT
Managing Fever in Young Infants
JWatch General 2004;2004:2-2.
FULL TEXT
Managing Fever in Young Infants: Experience Counts!
JWatch Infect. Diseases 2004;2004:7-7.
FULL TEXT
Young, Febrile Infants: A 30-Year Odyssey Ends Where It Started
Roberts
JAMA 2004;291:1261-1262.
FULL TEXT
|
