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The management of febrile infants by primary-care pediatricians in Utah: comparison with published practice
1Department of Pediatrics, University of Utah School of Medicine, Salt Lake City 84132, USA.
Insights
Primary care pediatricians manage febrile infants using fewer tests and hospitalizations than recommended. Compliance with guidelines varied significantly by infant age, with no pediatrician adhering to all recommendations.
Area of Science:
- Pediatrics
- Infectious Disease Management
- Clinical Practice Guidelines
Background:
- Febrile infants require careful management to rule out serious infections.
- Published practice guidelines offer age-specific strategies for evaluating febrile infants.
- Variations in clinical practice may impact adherence to evidence-based recommendations.
Purpose of the Study:
- To assess primary care pediatricians' management of febrile infants.
- To compare current practices with established clinical guidelines.
Main Methods:
- Case scenarios of febrile infants (21 days, 60 days, 20 months) were distributed to 194 Utah pediatricians.
- Pediatrician responses were analyzed for compliance with age-specific practice guidelines.
Main Results:
- A 48% response rate yielded 94 pediatrician participants.
- Guideline compliance was 39% (21-day-old), 9.6% (60-day-old), and 75% (20-month-old).
- No respondent fully complied with guidelines for all three infant cases; testing and hospitalization rates were lower than recommended.
Conclusions:
- Primary care pediatricians utilize fewer laboratory tests and hospitalizations for febrile infants than suggested by expert guidelines.
- Adherence to guidelines for febrile infant management is inconsistent among primary care providers.
Objective:
To determine primary-care pediatricians' management of febrile infants and compare them with published practice guidelines.
Design:
Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 months, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different strategies.
Results:
Ninety-four pediatricians responded (response rate, 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6% for the 60 day old, and 75% for the 20 month old. No respondent followed the guidelines for all three infants. Performance of tests to determine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a complete blood count in a 20 month old with a temperature of 40 degrees C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than those with more experience to follow the guidelines for the 21 day old but not the other two infants.
Conclusion:
Primary-care pediatricians in Utah manage febrile infants with fewer laboratory tests and less hospitalization than recent practice guidelines developed by an expert panel of academic specialists suggest.