Researchers have found that Canadian pediatric emergency departments vary substantially in the way they care for infants brought to the hospital with a fever.
Practice variation has been shown before, but it was among doctors working in general emergency departments as well as between pediatricians working in offices and those working in hospitals, says Dr. Ran Goldman, who headed the new study. His research focused on emergency departments at hospitals that specialize in the treatment of children.
Fever is one of the most common complaints in emergency departments, but the researchers couldn’t recruit all eligible children because the study had no funding, says Goldman, an associate professor of pediatrics at the University of British Columbia in Vancouver and head of pediatric emergency medicine at BC Children’s Hospital. The study involved 64 infants younger than 90 days old who were brought to one of six pediatric emergency departments with a temperature of at least 38 degrees Celsius.
The doctors performed blood and urine tests in most cases, but they ordered other tests, such as chest X-rays, in only one-third to two-thirds of cases. About one-third of the infants had a confirmed diagnosis of a serious bacterial infection, but no deaths were recorded. Antibiotics were prescribed at the same rate at the different centres, but the type of antibiotic varied. And use of anti-fever medication and intravenous fluids showed large variation.
Goldman says some of these differences, such as the ordering of chest X-rays, could be explained by the differing symptoms of the children, but more research is needed to explain the rest of the variation, and determine whether practice guidelines are needed to help doctors manage fever in infants.