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Fever under 3 months and the full septic screen: Time to think again? A retrospective cohort study at a tertiary‐level paediatric hospital
Author(s) -
Aldridge Patrick,
Rao Arjun,
Sethumadavan Rebecca,
Briggs Nancy
Publication year - 2018
Publication title -
journal of paediatrics and child health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.631
H-Index - 76
eISSN - 1440-1754
pISSN - 1034-4810
DOI - 10.1111/jpc.13743
Subject(s) - medicine , guideline , retrospective cohort study , cohort , emergency department , pediatrics , clinical endpoint , emergency medicine , clinical practice , population , cohort study , family medicine , clinical trial , environmental health , pathology , psychiatry
Aim To assess adherence to the Iocal guideline ( LG ) for the management of fever in infants under 3 months and whether the application of a risk‐stratified protocol ( RSP ) to this population would miss any serious bacterial infections ( SBI ) compared to current practice ( CP ) and LG . Methods All presentations to the authors’ Emergency Department of infants 0–3 months with fever from 1 July 2015 to 28 April 2016 were included ( n = 219), along with a detailed analysis of CP . The initial history, examination and pathology results were applied to the LG and RSP to assess what changes in management would occur. The primary end point was a missed SBI , with secondary outcomes measuring the number of invasive procedures performed, antibiotics prescribed and admissions. Results Adherence to the LG was 83% with three missed SBI s. Strict adherence would have resulted in eight missed SBI s. This indicates that both warranted and unwarranted variation exists in current clinical practice. Application of the RSP showed no missed SBIs but, compared to CP , indicates a statistically significant increase in admissions and full septic screens (admissions 95% vs. 83%, P < 0.05; full septic screens 82% vs. 72%, P < 0.05). Chest X‐rays were infrequently requested (10%) and the validity of use in this group warrants further study. Conclusion An ad hoc risk‐stratified practice already exists at the authors’ institution, and application of an RSP did not miss any SBIs . Adoption and implementation of a formal RSP is currently being formulated.