Monday, September 29, 2014

If You See One Emergency Department Approach to Febrile Infants, You See Only One of Many Approaches

By: Lewis First, MD, MS; Editor-in-Chief 
Photo by Joseph Nicola via Flickr

Nothing provokes more discussion in a clinical conference than asking, “What is the best way to diagnose and manage febrile infants when you don’t want to miss a serious bacterial infection?” Do all infants under 3-months-old need a full sepsis evaluation, some, none over a month, or is the approach solely dependent on immunization status of the child, family or community?

While algorithms and guidelines exist as to best practice based on evidence to date, what really happens in emergency departments when these children are evaluated?

Aronson et al. (doi: 10.1542/peds.2014-1382) share with us the results of a retrospective cohort of more than 17,000 infants seen in 37 different emergency departments (EDs) to look at patient and hospital level variation in diagnostic testing, treatment and disposition. The variations across EDs and patients is stark and worth your attention. If there was ever a need for a well-circulated, evidence-based common approach to these young infants and their fevers, this study certainly calls for one.

So what do you do with your febrile babies under 3 months of age? Do you follow a care pathway or guideline? If so, which one? Share with us your thoughts on your approach to febrile infants seen in emergency departments or your office by sending us your comments to this blog, via an eLetter, or on Facebook or Twitter.

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