1761. Effect of Clinical Practice Guideline Implementation on Febrile Infant Evaluation and Management
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall
Background: One in 10 infants ≤60 days old who present with fever will be diagnosed with a serious bacterial infection (SBI), which includes meningitis, bacteremia, and/or urinary tract infection. However, febrile infant management varies widely among practitioners.  A clinical practice guideline (CPG) was implemented in an urban children’s hospital with the aim of minimizing practice variation and improving clinical outcomes for febrile infants. The objective of this study is to determine the association of CPG implementation with diagnostic test and medical therapy use and clinical outcomes for febrile infant evaluations.

Methods: Infants ≤60 days old with a documented or caregiver-reported fever ≥38.0C from 1/1/09 – 1/31/11 (pre-CPG) and 2/1/11 – 1/31/13 (post-CPG) were included. Data on patient demographics, clinical presentation (including whether children met CPG-determined low-risk criteria for SBI), diagnostic tests, medications administered, and patient outcomes were collected.  Febrile infants were further divided into two age groups: 0-28 days and 29-60 days old, due to CPG recommendations differing based on this age criterion. Management practices and outcomes were compared between pre- and post-CPG periods.

Results: A total of 967 infants were identified pre-CPG and 843 infants post-CPG. Evaluation of infants 0-28 days old including complete blood count (CBC), blood and urine cultures, lumbar puncture (LP) and herpes simplex virus (HSV) testing did not significantly change after CPG implementation. Post-CPG, more infants 29-60 days old underwent LP (60% pre-CPG vs 69% post-CPG, p=0.0008) while fewer infants underwent HSV testing (14% pre-CPG vs 9% post-CPG, p=0.0055). Other testing (CBC, blood and urine cultures) remained unchanged for older infants. Antibiotic use decreased among low-risk infants 29-60 days old (83% pre-CPG vs 62% post-CPG, p <0.0001). Diagnosed SBI, hospital admission prevalence, and length of stay did not change after CPG implementation.

Conclusion: Antibiotic use and HSV testing decreased and LP obtainment increased for infants 29-60 days old after CPG implementation, representing changes toward adherence to CPG recommendations. These results suggest that CPG implementation reduced practice  variation at our institution.

Tessa Commers, MD, Pediatrics`, Children's Mercy Kansas City, Kansas City, MO, David Williams, MPH, Quality Improvement, Children's Mercy Hospitals & Clinics, Kansas City, MO, Jason Newland, MD, MEd, FPIDS, Children's Mercy Hospital and Clinics, Kansas City, MO, Keith Mann, MD, MEd, Quality Improvement, Children's Mercy Hospital and Clinics, Kansas City, MO, Jeffrey Michael, DO, Emergency Medicine, Children's Mercy Kansas City, Kansas City, MO, Jacqueline Bartlett, RN, PhD, Evidence Based Practice, Children's Mercy Hospital, Kansas City, MO, Mitchell Barnes, BS, Medical Informatics, Children's Mercy Kansas City, Kansas City, MO and Russell Mcculloh, MD, Pediatrics, Children's Mercy Hospitals & Clinics and University of Missouri-Kansas City, Kansas City, MO


T. Commers, None

D. Williams, None

J. Newland, Pfizer/Joint Commission: Grant Investigator , Research grant
RPSdiagnostics: Consultant , Consulting fee

K. Mann, None

J. Michael, None

J. Bartlett, None

M. Barnes, None

R. Mcculloh, None

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