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Does clinical presentation explain practice variability in the treatment of febrile infants?

David A Bergman1, Michelle L Mayer, Robert H Pantell

  • 1Division of General Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA. david.bergman@stanford.edu

Pediatrics
|March 3, 2006
PubMed

Insights

Clinical presentation of febrile infants explains nearly one third of treatment variability. Provider and practice characteristics have minimal impact on management decisions for febrile infants.

Area of Science:

  • Pediatric Medicine
  • Clinical Practice Variation
  • Infant Health

Background:

  • Significant variability exists in treating febrile infants, despite established practice guidelines.
  • Previous research has not fully elucidated the role of clinical severity in this treatment variability.

Purpose of the Study:

  • To quantify the impact of patient presentation, demographics, provider, practice, and regional factors on treatment variability for febrile infants.
  • To identify key drivers of differing evaluation and treatment strategies in pediatric care.

Main Methods:

  • Analysis of data from 2712 febrile infants across 194 practices and 484 pediatricians.
  • Utilized principal-components analysis to create a summary score for evaluation and treatment intensity.
  • Regressed the summary score against patient clinical presentation, demographics, provider/practice characteristics, and geographic region.

Main Results:

  • The patient's clinical characteristics accounted for 29.7% of the overall variance in treatment.
  • Practice site characteristics explained nearly 15% of the variance.
  • Provider/practitioner attributes and geographic region had minimal influence on practice variability.

Conclusions:

  • Patient clinical presentation is a primary determinant of management decisions for febrile infants, explaining a substantial portion of practice variability.
  • The severity of illness, as reflected in clinical presentation, is more influential than provider or regional factors in guiding treatment.
  • Findings underscore the importance of clinical assessment in standardizing care for febrile infants.
Abstract

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