Clinical judgments minimize infant hospitalizations

AORN Journal, August, 2004

A new study found that experienced pediatricians who relied on their clinical judgment more than existing clinical guidelines were able to minimize hospitalizations and avoid unnecessary laboratory testing for infants with fevers without negatively affecting outcomes of care, according to a March 9, 2004, news release from the Agency for Healthcare Research and Quality. The researchers worked with more than 573 clinicians' offices in 44 states. Included in the study were more than 3,000 infants three months old or younger who had no health problems other than a fever of at least 100.4[degrees] F (38[degrees] C).

Traditional clinical practice guidelines for treating infants with fevers recommend hospitalization and antibiotic treatment for all infants younger than one month of age and laboratory tests for all infants younger than three months of age. These expensive strategies are used to diagnose and treat infants with fever to protect them against bacterial meningitis and bacterial blood infections, which are illnesses that affect approximately 2% to 3% of infants with fevers.

Researchers found that clinicians treating infants with fevers

* followed clinical practice guidelines 42% of the time,

* performed laboratory tests on 75% of the infants, and

* treated 57% of the infants with antibiotics.

In the first month of life, 40% fewer infants were hospitalized when clinicians did not follow clinical practice guidelines but instead saw many infants in repeated office visits and performed frequent telephone follow-ups. Infants treated in the office and with follow-up visits experienced similar results to those treated following the guidelines.

New Study Suggests that Clinical Guidelines Used to Treat Infants With Fevers May Not Improve Outcomes (news release, Rockville, Md: Agency for Healthcare Research and Quality, March 9, 2004) http://www.ahrq .gov.news/press/pr2004/inffevpr.htm (accessed 17 March 2004).