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Time for Another Look at the Full-Term Infant from 7-90 Days with Fever in an Era of Immunization: Should We Still Worry About Sepsis Evaluations :

November 9, 2016

How we each approach a febrile infant nowadays is a study in practice variation despite several good articles that evidence-base a sound approach to diagnosing and managing this problem

 

How we each approach a febrile infant nowadays is a study in practice variation despite several good articles that evidence-base a sound approach to diagnosing and managing this problem (10.1542/peds.2012-0127). Does every febrile infant require blood, CSF and urine cultures? Is there an age when you might not do this and how consistent are we in who does and does not get cultured? 

 

Greenhow et al. (10.1542/peds.2016-0270) wanted to use big data to relook at these questions and chose Kaiser Permanente’s electronic health record (EHR) database to study all infants in this database who were previously healthy but developed fever at some point between 1 week and 3 months of age from 2010-2013. 1380 infants were identified from a database of over 96, 000 infants (1.4%),  Only 59% of febrile infants ages 7-28 days got a full sepsis evaluation, 25% if 29-60 days and 5% if 61-90 days.  If babies came to the office rather than the ED, they were less apt to get the full sepsis workup of cultures.  

Do these findings surprise you?  Wonder why not every infant gets cultured nowadays?  Wonder if infants that were not cultured in this study ended up having a serious bacterial infection?  Do you think any infants had bacteremia or meningitis—or was UTI the most likely diagnosis that surfaced? This is a great example of where big data can help us better understand practice trends and patterns and further add to the evidence-base of who does and does not need a sepsis evaluation.  Evaluate this study and see if your approach to this problem is what your colleagues in northern California are doing when confronted with a febrile infant in their office or in the emergency department.

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