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Variability in the management of the febrile infant under 2 months of age
Insights
Management of febrile infants under two months varies significantly across the US. Pediatric programs lack uniform emergency department practices for evaluating and treating these young febrile patients.
Area of Science:
- Pediatrics
- Emergency Medicine
- Infectious Disease
Background:
- Febrile infants under two months necessitate careful management in emergency departments.
- Community standards of practice significantly influence emergency department (ED) approaches to febrile infants.
- Variability in care for this vulnerable population raises concerns about consistent patient outcomes.
Purpose of the Study:
- To investigate the uniformity of emergency department management practices for febrile infants less than two months of age across the United States.
- To identify the extent of consensus on fever definition, diagnostic testing, and antibiotic administration for febrile infants.
Main Methods:
- A questionnaire was distributed to faculty at United States pediatric residency programs.
- Data were collected on institutional policies, guidelines, fever definitions, laboratory test utilization, and antibiotic prescribing practices.
- Response rates from 154 (61%) pediatric residency programs provided insights into current practices.
Main Results:
- Significant variability was observed in the emergency department management of febrile infants across responding institutions.
- Few programs (29) reported formal written policies, while more (103) had informal guidelines.
- Little consensus existed regarding the definition of fever, laboratory test selection, and antibiotic administration.
- Institutions with formal policies tended to use more laboratory tests.
Conclusions:
- There is a lack of standardized emergency department protocols for managing febrile infants less than two months old nationwide.
- The variability in diagnostic and treatment approaches highlights a need for evidence-based guidelines to ensure consistent and optimal care.
- Factors such as university affiliation or training programs did not correlate with the presence or type of institutional policy.
Abstract:
The management in the emergency department of febrile infants less than 2 months of age is influenced by the standard of practice in the community. We sought to determine if uniform practices existed across the United States. Individual academically based faculty from 154 (61%) United States pediatric residency programs responding to a questionnaire on the emergency department management of febrile infants less than 2 months of age showed great variability. Twenty-nine respondents reported written policies and 103 reported informal but defined guidelines for the evaluation and management of infants seen at their institutions. There was little consensus among the respondents as to the definition of fever in this age group. Those at institutions with formal policies reported using more laboratory tests in the evaluation. Respondents differed on the number and types of tests used and on antibiotic administration. University affiliation, type of population served, or presence of advanced training programs in ambulatory pediatrics were not related to the type of policy. The care of the young febrile infant varies greatly.