Does clinical presentation explain practice variability in the treatment of febrile infants?

Pediatrics
David A BergmanRichard C Wasserman

Abstract

Previous studies documented considerable variability in the treatment of febrile infants, despite the existence of practice guidelines for this condition. None of those studies documented the extent to which this variability is accounted for by differences in clinical severity. To quantify the individual effects of the patient's clinical presentation, demographic, provider, and practice characteristics, and regional variables on practice variability in the evaluation and treatment of febrile infants. With data collected through the Pediatric Research in Office Settings network, we analyzed data on the treatment of 2712 febrile infants examined by 484 pediatricians located in 194 practices. We analyzed hospitalization, lumbar puncture, urinalysis and/or urine culture, blood work, and initial antibiotic administration. We obtained a summary score for evaluation and treatment intensity (ranging from no tests or treatments to comprehensive testing, hospitalization, and antibiotic therapy) by performing principal-components analysis with these 5 variables. This summary score was regressed with respect to patients' clinical presentation, demographic and practice/practitioner features, and geographic region. Provider fixed effects wer...Continue Reading

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Citations

May 6, 2009·Archives of Pediatrics & Adolescent Medicine·Jennifer M StancilKatherine A Poehling
Jan 17, 2008·Current Opinion in Pediatrics·Bernadette Antonyrajah, Deepa Mukundan
Aug 7, 2013·Emergency Medicine Clinics of North America·Paul Ishimine
Oct 19, 2011·Current Problems in Pediatric and Adolescent Health Care·Eric J SloraRichard C Wasserman
Aug 8, 2009·Pediatric Clinics of North America·David C Goodman
Dec 18, 2013·Medical Education·Sílvia Mamede, Henk G Schmidt
Jul 1, 2009·Clinical Pediatrics·Catherine C FergusonLalit Bajaj
Sep 27, 2016·Pediatric Emergency Care·Nnenna Ogochukwu ChimeUNKNOWN INSPIRE Network
Dec 16, 2009·Journal of Physics. Condensed Matter : an Institute of Physics Journal·A B KlautauH M Petrilli
Jun 2, 2015·Journal of Physics. Condensed Matter : an Institute of Physics Journal·Corina EtzOlle Eriksson
Aug 7, 2019·Global Pediatric Health·Winston WuCourtney Mann
Jun 12, 2018·Journal of the American Medical Informatics Association : JAMIA·Russell J McCullohJason G Newland

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