CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System

Area of Science:

• Pediatrics
• Emergency Medicine
• Clinical Informatics

Background:

• Fever management in infants presenting to emergency departments (ED) lacks standardized approaches.
• Existing clinical guidelines, such as the Roseville Protocol (ROS) and American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG), have limitations.
• There is a need for refined algorithms to manage febrile infants effectively in community ED settings.

Purpose of the Study:

• To develop the California Febrile Infant Risk Stratification Tool (CA FIRST) by integrating components of the ROS and AAP CPG.
• To create a robust set of algorithms using community ED data for febrile infant risk stratification.
• To inform modifications of broader clinical guidance for managing febrile infants.

Main Methods:

• Retrospective analysis of 3527 febrile infants aged 7-90 days presenting to Kaiser Permanente Northern California EDs (2010-2019).
• Development of CA FIRST algorithms by melding ROS and AAP CPG components.
• Evaluation of CA FIRST performance characteristics and identification of enhancements for specific infant subgroups.

Main Results:

• CA FIRST algorithms demonstrated comparable performance to ROS and AAP CPG in infants aged 7-60 days.
• CA FIRST provides enhanced guidance for infants aged 61-90 days, high-risk infants, those with bronchiolitis, and post-vaccination fever.
• No invasive bacterial infections were observed in febrile infants with respiratory syncytial virus or post-vaccination fever within the study cohort.

Conclusions:

• The CA FIRST Algorithms offer a flexible and thoughtful approach to managing febrile infants, aiming to minimize unnecessary interventions.
• CA FIRST empowers clinicians with evidence-based tools for the management of most febrile infants.
• The algorithms are designed to be adaptive, incorporating new data within a learning healthcare system to provide current educational information.