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  • 1
    Online-Ressource
    Online-Ressource
    A Prediction Model to Identify Febrile Infants ≤60 Days at Low Risk of Invasive Bacterial Infection
    American Academy of Pediatrics (AAP) ; 2019
    In:  Pediatrics Vol. 144, No. 1 ( 2019-07-01)
    Details
    In: Pediatrics, American Academy of Pediatrics (AAP), Vol. 144, No. 1 ( 2019-07-01)
    Kurzfassung: To derive and internally validate a prediction model for the identification of febrile infants ≤60 days old at low probability of invasive bacterial infection (IBI). METHODS: We conducted a case-control study of febrile infants ≤60 days old who presented to the emergency departments of 11 hospitals between July 1, 2011 and June 30, 2016. Infants with IBI, defined by growth of a pathogen in blood (bacteremia) and/or cerebrospinal fluid (bacterial meningitis), were matched by hospital and date of visit to 2 control patients without IBI. Ill-appearing infants and those with complex chronic conditions were excluded. Predictors of IBI were identified with multiple logistic regression and internally validated with 10-fold cross-validation, and an IBI score was calculated. RESULTS: We included 181 infants with IBI (155 [85.6%] with bacteremia without meningitis and 26 [14.4%] with bacterial meningitis) and 362 control patients. Twenty-three infants with IBI (12.7%) and 138 control patients (38.1%) had fever by history only. Four predictors of IBI were identified (area under the curve 0.83 [95% confidence interval (CI): 0.79–0.86]) and incorporated into an IBI score: age & lt;21 days (1 point), highest temperature recorded in the emergency department 38.0–38.4°C (2 points) or ≥38.5°C (4 points), absolute neutrophil count ≥5185 cells per μL (2 points), and abnormal urinalysis results (3 points). The sensitivity and specificity of a score ≥2 were 98.8% (95% CI: 95.7%–99.9%) and 31.3% (95% CI: 26.3%–36.6%), respectively. All 26 infants with meningitis had scores ≥2. CONCLUSIONS: Infants ≤60 days old with fever by history only, a normal urinalysis result, and an absolute neutrophil count & lt;5185 cells per μL have a low probability of IBI.
    Materialart: Online-Ressource
    ISSN: 0031-4005 , 1098-4275
    URL: Article
    DOI: 10.1542/peds.2018-3604
    Sprache: Englisch
    Verlag: American Academy of Pediatrics (AAP)
    Publikationsdatum: 2019
    ZDB Id: 1477004-0
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 2
    Online-Ressource
    Online-Ressource
    Association of clinical practice guidelines with emergency department management of febrile infants ≤56 days of age
    Wiley ; 2015
    In:  Journal of Hospital Medicine Vol. 10, No. 6 ( 2015-06), p. 358-365
    Details
    In: Journal of Hospital Medicine, Wiley, Vol. 10, No. 6 ( 2015-06), p. 358-365
    Kurzfassung: Differences among febrile infant institutional clinical practice guidelines (CPGs) may contribute to practice variation and increased healthcare costs. OBJECTIVE Determine the association between pediatric emergency department (ED) CPGs and laboratory testing, hospitalization, ceftriaxone use, and costs in febrile infants. DESIGN Retrospective cross‐sectional study in 2013. SETTING Thirty‐three hospitals in the Pediatric Health Information System. PATIENTS Infants aged ≤56 days with a diagnosis of fever. EXPOSURES The presence and content of ED‐based febrile infant CPGs assessed by electronic survey. MEASUREMENTS Using generalized estimating equations, we evaluated the association between CPG recommendations and rates of urine, blood, cerebrospinal fluid (CSF) testing, hospitalization, and ceftriaxone use at ED discharge in 2 age groups: ≤28 days and 29 to 56 days. We also assessed CPG impact on healthcare costs. RESULTS We included 9377 ED visits; 21 of 33 EDs (63.6%) had a CPG. For neonates ≤28 days, CPG recommendations did not vary and were not associated with differences in testing, hospitalization, or costs. Among infants 29 to 56 days, CPG recommendations for CSF testing and ceftriaxone use varied. CSF testing occurred less often at EDs with CPGs recommending limited testing compared to hospitals without CPGs (adjusted odds ratio: 0.5, 95% confidence interval: 0.3‐0.8). Ceftriaxone use at ED discharge varied significantly based on CPG recommendations. Costs were higher for admitted and discharged infants 29 to 56 days old at hospitals with CPGs. CONCLUSIONS CPG recommendations for febrile infants 29 to 56 days old vary across institutions for CSF testing and ceftriaxone use, correlating with observed practice variation. CPGs were not associated with lower healthcare costs. Journal of Hospital Medicine 2015;10:358–365. © 2015 Society of Hospital Medicine
    Materialart: Online-Ressource
    ISSN: 1553-5592 , 1553-5606
    URL: Issue
    URL: Article
    DOI: 10.1002/jhm.v10.6
    DOI: 10.1002/jhm.2329
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2015
    ZDB Id: 2221544-X
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
  • 3
    Online-Ressource
    Online-Ressource
    Accuracy of diagnosis codes to identify febrile young infants using administrative data
    Wiley ; 2015
    In:  Journal of Hospital Medicine Vol. 10, No. 12 ( 2015-12), p. 787-793
    Details
    In: Journal of Hospital Medicine, Wiley, Vol. 10, No. 12 ( 2015-12), p. 787-793
    Kurzfassung: Administrative data can be used to determine optimal management of febrile infants and aid clinical practice guideline development. OBJECTIVE Determine the most accurate International Classification of Diseases, Ninth Revision (ICD‐9) diagnosis coding strategies for identification of febrile infants. DESIGN Retrospective cross‐sectional study. SETTING Eight emergency departments in the Pediatric Health Information System. PATIENTS Infants aged 〈 90 days evaluated between July 1, 2012 and June 30, 2013 were randomly selected for medical record review from 1 of 4 ICD‐9 diagnosis code groups: (1) discharge diagnosis of fever, (2) admission diagnosis of fever without discharge diagnosis of fever, (3) discharge diagnosis of serious infection without diagnosis of fever, and (4) no diagnosis of fever or serious infection. EXPOSURE The ICD‐9 diagnosis code groups were compared in 4 case‐identification algorithms to a reference standard of fever ≥100.4 ° F documented in the medical record. MEASUREMENTS Algorithm predictive accuracy was measured using sensitivity, specificity, and negative and positive predictive values. RESULTS Among 1790 medical records reviewed, 766 (42.8%) infants had fever. Discharge diagnosis of fever demonstrated high specificity (98.2%, 95% confidence interval [CI]: 97.8‐98.6) but low sensitivity (53.2%, 95% CI: 50.0‐56.4). A case‐identification algorithm of admission or discharge diagnosis of fever exhibited higher sensitivity (71.1%, 95% CI: 68.2‐74.0), similar specificity (97.7%, 95% CI: 97.3‐98.1), and the highest positive predictive value (86.9%, 95% CI: 84.5‐89.3). CONCLUSIONS A case‐identification strategy that includes admission or discharge diagnosis of fever should be considered for febrile infant studies using administrative data, though underclassification of patients is a potential limitation. Journal of Hospital Medicine 2015;10:787–793. © 2015 Society of Hospital Medicine
    Materialart: Online-Ressource
    ISSN: 1553-5592 , 1553-5606
    URL: Issue
    URL: Article
    DOI: 10.1002/jhm.v10.12
    DOI: 10.1002/jhm.2441
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2015
    ZDB Id: 2221544-X
    Standort Signatur Einschränkungen Verfügbarkeit
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    Online-Ressource
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