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Is care in alternative settings safe for infants with possible serious bacterial infection?
Anne F Brayer1, Gregory P Conners, Tashveen Kaur
1Department of Emergency Medicine, University of Rochester Medical Center, NY 14642, USA.
Insights
Hospitalizing febrile infants for possible serious bacterial illness (SBI) may be reduced. Selected infants are safe for alternative setting care (ASC), showing no deterioration and compatible resource use.
Area of Science:
- Pediatrics
- Infectious Diseases
- Healthcare Management
Background:
- Febrile infants are commonly hospitalized for potential serious bacterial illness (SBI).
- Evaluating alternative care settings could optimize resource utilization and patient management.
Purpose of the Study:
- To assess the safety and feasibility of alternative setting care (ASC) for selected febrile infants.
- To estimate the risk of clinical deterioration and evaluate resource use in ASC.
Main Methods:
- Retrospective review of medical records for hospitalized febrile infants (1994-1998).
- Focus on infants with positive blood or cerebrospinal fluid cultures indicative of SBI.
- Risk assessment for deterioration and analysis of resource utilization in potential ASC candidates.
Main Results:
- No infant eligible for ASC with a positive blood culture experienced deterioration.
- The estimated upper bound risk for deterioration in ASC was 0.56% (95% CI).
- Resource utilization patterns were found to be compatible with ASC.
Conclusions:
- Alternative setting care (ASC) is a safe and feasible option for carefully selected febrile infants.
- This approach has the potential to reduce hospitalizations for possible SBI.
Abstract:
Febrile infants are frequently hospitalized for possible serious bacterial illness (SBI). Potential to replace hospitalization of selected febrile infants with care in alternative settings was assessed by estimating risk for deterioration and by determining resource use. Lower and upper bound estimates for the number of infants admitted to a tertiary care hospital from 1994 to 1998 for possible SBI were 537 and 836, respectively. Detailed record reviews were conducted for febrile infants among this group, who, on the basis of positive blood or cerebrospinal cultures, were considered most likely to have SBI. No infant with a positive blood culture who was eligible for alternative setting care (ASC) deteriorated. Ninety-five percent confidence interval for the worst-case (assuming denominator of 537) estimate of risk for deterioration was 0% to 0.56%. Most resource use was compatible with ASC. Alternative setting care for selected febrile infants is both safe and feasible.