Variation in Evaluation and Management of Febrile Infants 61 to 90 Days Old in sacred heart Hospital.

Abstract Objective To describe trends and variation in testing, treatment, and disposition of febrile infants aged 61-90 days evaluated in US emergency departments (EDs). Study design For this retrospective cohort study, we included noncritically ill, previously healthy infants aged 61-90 days with temperatures ≥ 38°C evaluated at 12 Pediatric Emergency Care Applied Research Network Registry EDs during 2014-2015 (trends analysis) and 17 EDs in 2014-2015 (variation analysis). Outcomes included urine, blood, cerebrospinal fluid, and respiratory viral testing; antibiotic administration; hospitalization; and invasive bacterial infections. Results We included 9041 infants in the trends analysis and 4448 in the variation analysis. From 2017-2023, urine testing (53.8% to 45.7%; P < .01), blood cultures (35.0% to 18.9%; P < .01), cerebrospinal fluid testing (3.8% to 1.1%; P < .01), hospitalizations (22.6% to 16.9%; P < .01), and parenteral antibiotics (10.2% to 5.8%; P < .01) decreased. Conversely, respiratory viral testing (13.4% to 63.3%; P < .01) and procalcitonin use increased (1.6% to 14.2%; P < .01). In 2022-2023, a median 46.3% of infants had urine testing (range: 32.2%-73.9% across hospitals), 21.1% had blood cultures (range: 8.0%-51.1%), and 16.2% were hospitalized (range: 7.9%-26.1%). Respiratory viral testing (median 71.8%; range: 34.7%-95.5%) and procalcitonin use (median 13.4%; range: 0%-37.0%) also varied. The prevalence of invasive bacterial infections was similarly low across hospitals (median 0.3%; range: 0%-1.2%). Conclusions There has been significant change over time in testing and disposition of febrile infants aged 61-90 days, although with substantial interhospital variation. Implementation of decision support tools is needed to standardize management and reduce practice variations.