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Resource Utilization and Cost in Management of Febrile Infants After the 2021 Clinical Guideline
Elena Dingle1,2, Jonathan H Pelletier2,3, Michael L Forbes2,4
1Department of Graduate Medical Education, Akron Children's Hospital, Akron, Ohio.
Insights
The 2021 American Academy of Pediatrics guideline for febrile infants reduced hospitalizations and antibiotic use. However, it was associated with a slight increase in delayed diagnoses of bacteremia and sepsis in younger infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Health Services Research
Background:
- The 2021 American Academy of Pediatrics clinical practice guideline (CPG) for well-appearing febrile infants aimed to standardize care and reduce variability.
- Evaluating febrile infants involves significant resource utilization, including laboratory tests, imaging, and antimicrobial administration.
- Understanding the impact of the CPG on resource use and cost is crucial for assessing its effectiveness.
Purpose of the Study:
- To examine trends in resource utilization and cost for evaluating and managing febrile infants (8-60 days old) before and after the 2021 CPG.
- To assess the impact of the CPG on hospitalization rates, antibiotic use, and diagnostic testing.
Main Methods:
- Retrospective cross-sectional study using the Pediatric Health Information Systems Database.
- Analysis of data from August 2019-July 2021 (pre-CPG) and August 2021-July 2023 (post-CPG).
- Evaluation of antibiotic, acyclovir, laboratory studies, lumbar puncture (LP), and hospitalization trends.
Main Results:
- Post-CPG, hospitalizations decreased by 7.9%, antibiotic/acyclovir use by 8.8%, and LPs by 9.9%.
- Use of C-reactive protein and procalcitonin increased post-CPG.
- Age-stratified analysis showed reduced hospitalizations and LPs in infants >22 days, but a slight increase in delayed bacteremia/sepsis diagnosis in infants <28 days.
Conclusions:
- The 2021 CPG appears effective in reducing hospitalization, antimicrobial use, and LPs in infants over 22 days old.
- A potential trade-off includes a slight increase in delayed diagnosis of bacteremia and sepsis in infants younger than 28 days.
- Further research is needed to optimize CPG implementation for the youngest febrile infants.
Objective:
The 2021 American Academy of Pediatrics clinical practice guideline (CPG) for well-appearing febrile infants aims to promote evidence-based care, reduce practice variability, enhance care quality, and optimize cost. We aimed to examine the trends in resource utilization and cost associated with the evaluation and management of febrile infants aged 8 to 60 days before and after the CPG's publication.
Methods:
We performed a retrospective cross-sectional study using the Pediatric Health Information Systems Database, covering the periods of August 2019 to July 2021 (pre-CPG) and August 2021 to July 2023 (post-CPG). We analyzed the use of antibiotics, acyclovir, laboratory studies, lumbar punctures (LPs), and hospitalizations before and after the CPG publication.
Results:
We identified 33 736 encounters (12 220 pre-CPG and 21 516 post-CPG). After the CPG, there was a decrease in hospitalization (42.6% vs 34.7%, -7.9% [-9.0% to -6.8%]), antibiotic and acyclovir administration (41.9% vs 33.1%, -8.8% [-9.9% to -7.7%]; 9.7% vs 7.3%, -2.4% [-3.1% to -1.8%]), and LP (31.7% vs 21.8%, -9.9% [-10.9% to -8.9%]). Conversely, the use of C-reactive protein (23.7% vs 32.3%, 8.6% [7.6% to 9.5%]) and procalcitonin (40.1% vs 64.5%, 24.4% [23.3% to 25.5%]) increased. Cost remained unchanged. Age-stratified analysis revealed a significant reduction in hospitalization, antibiotic use, and LP in infants aged older than 22 days, whereas infants younger than 28 days experienced a slight increase in delayed diagnosis of bacteremia and sepsis after the CPG.
Conclusions:
After the CPG, hospitalization, antimicrobial use, and LPs decreased in infants aged older than 22 days, indicating that the CPG may be effective in reducing resource utilization. There was a slight increase in delayed diagnosis of bacteremia and sepsis in infants younger than 28 days.
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