Kao-Ping Chua1, Mark I Neuman2, J Michael McWilliams3, Paul L Aronson4. 1. Division of Emergency Medicine at Boston Children's Hospital, Boston, MA. Electronic address: kaopingchua@uchicago.edu. 2. Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA. 3. Department of Health Care Policy, Harvard Medical School, Boston, MA; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA. 4. Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT.
Abstract
OBJECTIVE: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days. STUDY DESIGN: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year. RESULTS: The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI -0.18 to 0.85; P = .22). CONCLUSIONS: Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.
OBJECTIVE: To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days. STUDY DESIGN: Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year. RESULTS: The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI -0.18 to 0.85; P = .22). CONCLUSIONS: Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.
Authors: Paul L Aronson; Cary Thurm; Elizabeth R Alpern; Evaline A Alessandrini; Derek J Williams; Samir S Shah; Lise E Nigrovic; Russell J McCulloh; Amanda Schondelmeyer; Joel S Tieder; Mark I Neuman Journal: Pediatrics Date: 2014-10 Impact factor: 7.124
Authors: Paul L Aronson; Cary Thurm; Derek J Williams; Lise E Nigrovic; Elizabeth R Alpern; Joel S Tieder; Samir S Shah; Russell J McCulloh; Fran Balamuth; Amanda C Schondelmeyer; Evaline A Alessandrini; Whitney L Browning; Angela L Myers; Mark I Neuman Journal: J Hosp Med Date: 2015-02-13 Impact factor: 2.960
Authors: Aaron L Schwartz; Bruce E Landon; Adam G Elshaug; Michael E Chernew; J Michael McWilliams Journal: JAMA Intern Med Date: 2014-07 Impact factor: 21.873
Authors: J A Jaskiewicz; C A McCarthy; A C Richardson; K C White; D J Fisher; R Dagan; K R Powell Journal: Pediatrics Date: 1994-09 Impact factor: 7.124
Authors: L J Baraff; J W Bass; G R Fleisher; J O Klein; G H McCracken; K R Powell; D L Schriger Journal: Ann Emerg Med Date: 1993-07 Impact factor: 5.721
Authors: Paul L Aronson; Marie E Wang; Eugene D Shapiro; Samir S Shah; Adrienne G DePorre; Russell J McCulloh; Christopher M Pruitt; Sanyukta Desai; Lise E Nigrovic; Richard D Marble; Rianna C Leazer; Sahar N Rooholamini; Laura F Sartori; Fran Balamuth; Christopher Woll; Mark I Neuman Journal: Pediatrics Date: 2018-11-13 Impact factor: 7.124
Authors: Colleen K Gutman; K Casey Lion; Paul Aronson; Carla Fisher; Carma Bylund; Antionette McFarlane; Xiangyang Lou; Mary D Patterson; Ahmed Lababidi; Rosemarie Fernandez Journal: BMJ Open Date: 2022-09-20 Impact factor: 3.006