Outcomes after modified PECARN procalcitonin rule implementation in febrile infant care process model

Stratification of well-appearing febrile infants into a low-risk category for invasive bacterial infections (IBI) is critical to optimizing patient care. Procalcitonin, a biomarker associated with bacterial infection, was included in the 2019 PECARN clinical prediction rule to identify febrile infants 60 days and younger at low risk for serious bacterial infection. That same year, we incorporated a modified PECARN febrile infant prediction rule into our existing febrile infant algorithm. The primary objective of the study was to evaluate the effect of the modified PECARN prediction rule on rate of lumbar puncture (LP), hospital admissions, and 30-day readmissions.

e identified febrile infants 3 to 90 days evaluated in our emergency department from November 2017 through April 2022. The pre-implementation period was from 11/2017 through 6/2019. The modified PECARN rule was incorporated into the clinical care process model between 7/2019 and 8/2019. The post-implementation period was 9/2019 through 4/2022. The primary outcomes were LP rate and hospital admissions. The primary process metric was procalcitonin obtainment. The balancing metric was 30-day readmissions. Between group comparisons were performed with Chi square tests.

A total of 1520 febrile infants were included in the analysis, 662 in the pre-implementation period, and 858 in the post-implementation period. LP rate and hospital admissions decreased from 45.8% to 31.0% (p<0.001) and from 54.1% to 43.2% (p<0.001), respectively. The percentage of infants with a procalcitonin increased from 3.9% to 94.1% post-implementation (P<0.001). The 30-day readmission rate was 3.5% in the pre-implementation and 4.8% in the post-implementation period (p = 0.26).

Incorporation of the modified PECARN prediction rule to an existing febrile infant care process model resulted in decreased lumbar punctures and hospital admissions without significantly increasing 30-day readmissions.