Perceived Utility of Respiratory Virus Testing for Febrile Infants Under Six-Weeks of Age Among Canadian Pediatric Emergency and Inpatient Physicians
CPS ePoster Library. Burstein B. Jun 25, 2015; 99081; 18
Dr. Brett Burstein
Dr. Brett Burstein
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Background: Well appearing febrile infants with viral illnesses cannot be easily distinguished from those with occult life-threatening infections by history and physical exam alone. This national practice variation study sought to assess current approaches to febrile infants under 6 weeks of age, and determine how management is influenced by respiratory virus testing.

Methods: A scenario-based survey describing 2 hypothetical cases of febrile infants without a focus aged 3 and 5 weeks was sent to ED and inpatient physicians at all 16 pediatric tertiary centers across Canada. Participants were asked multiple-choice questions regarding management decisions with and without results of respiratory virus testing. Chi-square testing was used to compare proportions and corrected for multiple comparisons.

Results: Response rate was 78% (n = 330; 190 ED physicians, 140 inpatient physicians). Based on the hypothetical scenarios, Investigations most commonly performed for both 3- and 5-week-old infants were urine culture, urine analysis, CBC and blood culture. Lumbar puncture was performed less frequently in 5-week-old infants (49% vs. 93%, p<0.0001), as was respiratory virus testing (34% vs. 46%, p<0.05). There were significant variations in rates of viral testing between centers. Detection of a respiratory virus reduced admission rates among both 3-week (83% vs. 95%, p<0.001) and 5-week-old infants (36% vs. 52%, p<0.001). Similarly, initiation of empiric antibiotic treatment was decreased by detection of a respiratory virus among both 3-week (65% vs. 92%, p<0.001) and 5-week-old infants (25% vs. 39%, p<0.001). Inpatient physicians were more likely than ED physicians to admit (68% vs. 41%, p<0.001) and start antibiotic therapy (51% vs. 30%, p<0.001) in 5-week-old infants. Among inpatient physicians, 81% would discharge 5-week-old infants with a detectable respiratory virus in ≤24 hours; whereas hospitalization duration for 3-week-old infants was highly variable.

Conclusions: The management of febrile infants under 6-weeks differs between ED and inpatient physicians, and by infant age. Respiratory virus testing appears to influence the management of febrile young infants. Establishment of clinical guidelines and prospective evaluation of viral testing for risk stratification of this patient population is warranted.
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