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Outcomes of Infants Who Are Febrile Aged 29-90 Days Discharged from the Emergency Department
Shiri Curelaru1, Nir Samuel2, Gilad Chayen3
1Pediatric Department, Ha'Emek Medical Center, Afula, Israel.
Insights
Febrile infants aged 29-90 days discharged from the pediatric emergency department (ED) had a high return visit rate. However, serious infections and deaths were rare, indicating a safe discharge pathway.
Area of Science:
- Pediatrics
- Emergency Medicine
- Infectious Diseases
Background:
- Febrile infants under 3 months old present a diagnostic challenge in the pediatric emergency department (ED).
- Discharge protocols aim to balance the risk of missing serious infections with the burden of hospitalization.
Purpose of the Study:
- To evaluate the characteristics and outcomes of febrile infants aged 29-90 days discharged from the pediatric ED.
- To identify factors associated with return visits (RV) in this population.
Main Methods:
- Multicenter, retrospective cohort study of 1647 infants aged 29-90 days discharged from pediatric EDs.
- Inclusion criteria: fever and blood/urine cultures obtained prior to discharge.
- Primary outcome: incidence of ED return visits within 120 hours; secondary outcomes: invasive bacterial infection, UTI, PICU admission, death.
Main Results:
- A total of 329 patients (20%) returned to the ED within 120 hours.
- Positive urine culture rate was 7.8%; positive blood culture rate was 0.2%.
- No cases of meningitis were reported; one infant required PICU admission; no deaths occurred.
Conclusions:
- Febrile infants aged 29-90 days discharged from the pediatric ED via a protocol-driven pathway exhibit a notable return visit rate.
- Despite the high RV rate, the incidence of urinary tract infections and invasive bacterial infections was low, with no reported deaths or severe sequelae.
Objective:
To evaluate the characteristics and outcomes of infants aged 29-90 days who are febrile discharged from the pediatric emergency department (ED).
Study Design:
This was a multicenter, retrospective cohort study of infants aged 29-90 days who visited any of the 7 Clalit Health Services pediatric EDs in Israel between January 1, 2019, and March 31, 2022. Infants who were febrile discharged from the ED after having blood and urine cultures taken were included. The primary outcome measure was the incidence of return visit (RV) to an ED. Secondary outcome measures were the incidence of invasive bacterial infection, urinary tract infection, pediatric intensive care unit admissions, and deaths. We assessed variables associated with the primary outcomes.
Results:
A total of 1647 infants were included. Their median (IQR) age at ED visit was 58.5 (47.7, 72.7) days, 53.1% were male. A total of 329 patients (20%) returned to the ED within 120 hours. Overall, 7.8% of discharged infants had a positive urine culture, 4 (0.2%) had a positive blood culture, and none had meningitis. One patient was admitted to the pediatric intensive care unit, and there was no death. Abnormal C-reactive protein was associated with RV among 61- to 90-day-old infants.
Conclusions:
Infants aged 29-90 days who were febrile and discharged following a protocol-driven pathway from the pediatric ED had a relatively high RV rate. However, the rate of urinary tract infection was relatively low, and rate of invasive bacterial infection was extremely low. There were no deaths or serious sequelae.
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