Discrepancies Between the Management of Fever in Young Infants Admitted From Urban General Emergency Departments and Pediatric Emergency Departments.

INTRODUCTION/OBJECTIVE: Most pediatric emergency visits occur in general emergency departments (GED). Our study aims to assess whether medical decision making regarding the management of febrile infants differs in GEDs from pediatric EDs (PED) and deviates from pediatric expert consensus. METHODS: We conducted a retrospective chart review on patients younger than 60 days with fever admitted from 13 GEDs versus 1 PED to a children's hospital over a 3-year period. Adherence to consensus guidelines was measured by frequency of performing critical components of initial management, including blood culture, urine culture, attempted lumbar puncture, and antibiotic administration (<29 days old), or complete blood count and/or C-reactive protein, blood culture, and urine culture (29-60 days old). Additional outcomes included lumbar puncture, collecting urine specimens via catheterization, and timing of antibiotics. RESULTS: A total of 176 patient charts were included. Sixty-four (36%) patients were younger than 29 days, and 112 (64%) were 29 to 60 days old. Eighty-eight (50%) patients were admitted from GEDs.In infants younger than 29 days managed in the GEDs (n = 32), 65.6% (n = 21) of patients underwent all 4 critical items compared with 96.9% (n = 31, P = 0.003) in the PED. In infants 29 to 60 days old managed in GEDs (n = 56), 64.3% (n = 36) patients underwent all 3 critical items compared with 91.1% (n = 51, P < 0.001) in the PED. CONCLUSIONS: This retrospective study suggests that providers managing young infants with fever in 13 GEDs differ significantly from providers in the PED examined and literature consensus. Inconsistent testing and treatment practices may put young infants at risk for undetected bacterial infection.

Pediatric Care in the Nonpediatric Emergency Department: Provider Perspectives.

OBJECTIVES: Most pediatric emergency visits are to nonpediatric emergency departments (EDs), and little is known about provider comfort level with pediatric patients. We aimed to assess providers' comfort level caring for pediatric patients of different age groups and perceived resources and barriers to delivering evidence-based pediatric care. METHODS: We conducted an anonymous electronic survey of providers (physicians, nurse practitioners, and physician assistants) in nonpediatric EDs in an urban area who admit to a single quaternary-care children's hospital. Questions addressed provider comfort in examining, diagnosing, and treating patients across 4 age groups; access to management guidelines; resources for education; and benefits of feedback from inpatient providers. Comfort was assessed with a 5-point Likert scale, with "comfortable" being defined as a 4 or 5. The association between patient age and provider comfort was analyzed by using logistic regression with generalized estimating equations. RESULTS: We surveyed 375 providers. Our response rate was 26% (14% nurse practitioners, 34% physician assistants, and 51% physicians). Of respondents, <50% report being comfortable caring for patients <3 months of age (46% examining, 38% diagnosing, 46% treating). Thirteen percent found it mostly or very easy to keep up with pediatric management guidelines (n = 12); cited barriers were time constraints, a lack of access to journals or pediatric experts, and low institutional priority due to low pediatric volume. CONCLUSIONS: This study suggests that nonpediatric ED providers' comfort in caring for pediatric patients decreases with decreasing patient age. Less than half of providers report that they are comfortable managing patients <3 months old.