Paul L Aronson1, Cary Thurm2, Elizabeth R Alpern3, Evaline A Alessandrini4, Derek J Williams5, Samir S Shah6, Lise E Nigrovic7, Russell J McCulloh8, Amanda Schondelmeyer9, Joel S Tieder10, Mark I Neuman7. 1. Department of Pediatrics, Section of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut; paul.aronson@yale.edu. 2. Children's Hospital Association, Overland Park, Kansas; 3. Division of Emergency Medicine, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois; 4. Divisions of Emergency Medicine. 5. Division of Hospital Medicine, Department of Pediatrics, The Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University School of Medicine, Nashville, Tennessee; 6. Hospital Medicine, and Infectious Diseases, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio; 7. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; 8. Division of Infectious Diseases, Department of Pediatrics, Children's Mercy Hospitals & Clinics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; and. 9. Hospital Medicine, and. 10. Division of Hospital Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington.
Abstract
BACKGROUND AND OBJECTIVES: Variation in patient care or outcomes may indicate an opportunity to improve quality of care. We evaluated the variation in testing, treatment, hospitalization rates, and outcomes of febrile young infants in US pediatric emergency departments (EDs). METHODS: Retrospective cohort study of infants <90 days of age with a diagnosis code of fever who were evaluated in 1 of 37 pediatric EDs between July 1, 2011 and June 30, 2013. We assessed patient- and hospital-level variation in testing, treatment, and disposition for patients in 3 distinct age groups: ≤28, 29 to 56, and 57 to 89 days. We also compared interhospital variation for 3-day revisits and revisits resulting in hospitalization. RESULTS: We identified 35,070 ED visits that met inclusion criteria. The proportion of patients who underwent comprehensive evaluation, defined as urine, serum, and cerebrospinal fluid testing, decreased with increasing patient age: 72.0% (95% confidence interval [CI], 71.0-73.0) of neonates ≤28 days, 49.0% (95% CI, 48.2-49.8) of infants 29 to 56 days, and 13.1% (95% CI, 12.5-13.6) of infants 57 to 89 days. Significant interhospital variation was demonstrated in testing, treatment, and hospitalization rates overall and across all 3 age groups, with little interhospital variation in outcomes. Hospitalization rate in the overall cohort did not correlate with 3-day revisits (R(2) = 0.10, P = .06) or revisits resulting in hospitalization (R(2) = 0.08, P = .09). CONCLUSIONS: Substantial patient- and hospital-level variation was observed in the ED management of the febrile young infant, without concomitant differences in outcomes. Strategies to understand and address the modifiable sources of variation are needed.
BACKGROUND AND OBJECTIVES: Variation in patient care or outcomes may indicate an opportunity to improve quality of care. We evaluated the variation in testing, treatment, hospitalization rates, and outcomes of febrile young infants in US pediatric emergency departments (EDs). METHODS: Retrospective cohort study of infants <90 days of age with a diagnosis code of fever who were evaluated in 1 of 37 pediatric EDs between July 1, 2011 and June 30, 2013. We assessed patient- and hospital-level variation in testing, treatment, and disposition for patients in 3 distinct age groups: ≤28, 29 to 56, and 57 to 89 days. We also compared interhospital variation for 3-day revisits and revisits resulting in hospitalization. RESULTS: We identified 35,070 ED visits that met inclusion criteria. The proportion of patients who underwent comprehensive evaluation, defined as urine, serum, and cerebrospinal fluid testing, decreased with increasing patient age: 72.0% (95% confidence interval [CI], 71.0-73.0) of neonates ≤28 days, 49.0% (95% CI, 48.2-49.8) of infants 29 to 56 days, and 13.1% (95% CI, 12.5-13.6) of infants 57 to 89 days. Significant interhospital variation was demonstrated in testing, treatment, and hospitalization rates overall and across all 3 age groups, with little interhospital variation in outcomes. Hospitalization rate in the overall cohort did not correlate with 3-day revisits (R(2) = 0.10, P = .06) or revisits resulting in hospitalization (R(2) = 0.08, P = .09). CONCLUSIONS: Substantial patient- and hospital-level variation was observed in the ED management of the febrile young infant, without concomitant differences in outcomes. Strategies to understand and address the modifiable sources of variation are needed.
Authors: Paul L Aronson; Marie E Wang; Lise E Nigrovic; Samir S Shah; Sanyukta Desai; Christopher M Pruitt; Fran Balamuth; Laura Sartori; Richard D Marble; Sahar N Rooholamini; Rianna C Leazer; Christopher Woll; Adrienne G DePorre; Mark I Neuman Journal: Hosp Pediatr Date: 2018-07
Authors: Jessica L Markham; Matthew Hall; Mary Ann Queen; Paul L Aronson; Sowdhamini S Wallace; Dana M Foradori; Gabrielle Hester; Jennifer Nead; Michelle A Lopez; Andrea T Cruz; Russell J McCulloh Journal: Hosp Pediatr Date: 2019-01
Authors: Paul L Aronson; Todd W Lyons; Andrea T Cruz; Stephen B Freedman; Pamela J Okada; Alesia H Fleming; Joseph L Arms; Amy D Thompson; Suzanne M Schmidt; Jeffrey Louie; Michael J Alfonzo; Michael C Monuteaux; Lise E Nigrovic Journal: J Pediatr Date: 2017-07-10 Impact factor: 4.406
Authors: Elana A Feldman; Russell J McCulloh; Angela L Myers; Paul L Aronson; Mark I Neuman; Miranda C Bradford; Elizabeth R Alpern; Frances Balamuth; Mercedes M Blackstone; Whitney L Browning; Katie Hayes; Rosalynne Korman; Rianna C Leazer; Lise E Nigrovic; Richard Marble; Emily Roben; Derek J Williams; Joel S Tieder Journal: Hosp Pediatr Date: 2017-07-20
Authors: Elizabeth R Alpern; Nathan Kuppermann; Stephen Blumberg; Genie Roosevelt; Andrea T Cruz; Lise E Nigrovic; Lorin R Browne; John M VanBuren; Octavio Ramilo; Prashant Mahajan Journal: Hosp Pediatr Date: 2020-09