Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days

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• 作者：Kao-Ping Chua ; MD ; PhD¹ ; ^&lowast ; ; ^{kaopingchua@uchicago.edu" class="auth_mail" title="E-mail the corresponding author} ; Mark I. Neuman ; MD ; MPH² ; J. Michael McWilliams ; MD ; PhD³ ; ⁴ ; ^&dagger ; ; Paul L. Aronson ; MD⁵ ; ^&dagger ; ; on behalf of the Febrile Young Infant Research Collaborative^&Dagger ; Cary Thurm ; PhD ; Derek J. Williams ; MD ; MPH ; Whitney L. Browning ; MD ; Lise E. Nigrovic ; MD ; MPH ; Elizabeth R. Alpern ; MD ; MSCE ; Joel S. Tieder ; MD ; MPH ; Elana A. Feldman ; BA ; Samir S. Shah ; MD ; MSCE ; Amanda C. Schondelmeyer ; MD ; Evaline A. Alessandrini ; MD ; MSCE ; Russell J. McCulloh ; MD ; Angela L. Myers ; MD ; MPH ; Fran Balamuth ; MD ; PhD ; MSCE ; Katie L. Hayes ; BS
• 关键词：CPG ; Clinical practice guideline ; CSF ; Cerebrospinal fluid ; ED ; Emergency department ; ICD-9 ; International Classification of Diseases ; Ninth Revision ; PHIS ; Pediatric Health Information System
• 刊名：The Journal of Pediatrics
• 出版年：2015
• 出版时间：December 2015
• 年：2015
• 卷：167
• 期：6
• 页码：1340-1346.e9
• 全文大小：924 K

文摘

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.