Ramgopal Sriram, Aronson Paul L, Marin Jennifer R
Northwestern University Feinberg School of Medicine, Department of Emergency Medicine, Chicago, Illinois.
Yale School of Medicine, Departments of Pediatrics and Emergency Medicine, New Haven, Connecticut.
West J Emerg Med. 2020 Oct 27;21(6):146-151. doi: 10.5811/westjem.2020.8.47455.
Our goal in this study was to estimate rates of emergency department (ED) visits for fever by children <2 years of age, and evaluate frequencies of testing and treatment during these visits.
We performed a cross-sectional study of ED encounters from 2007-2017 using the National Hospital Ambulatory Medical Care Survey, a cross-sectional, multi-stage probability sample survey of visits to nonfederal United States EDs. We included encounters with a visit reason of "fever" or recorded fever in the ED. We report demographics and management strategies in two groups: infants ≤90 days in age; and children 91 days to <2 years old. For patients 91 days to <2 years, we compared testing and treatment strategies between general and pediatric EDs using chi-squared tests.
Of 1.5 billion encounters over 11 years, 2.1% (95% confidence interval [CI], 1.9-2.2%) were by children <2 years old with fever. Two million encounters (95% CI, 1.7-2.4 million) were by infants ≤90 days, and 28.4 million (95% CI, 25.5-31.4 million) were by children 91 days to <2 years. Among infants ≤90 days, 27.6% (95% CI, 21.1-34.1%) had blood and 21.3% (95% CI, 13.6-29.1%) had urine cultures; 26.8% (95% CI, 20.9-32.7%) were given antibiotics, and 21.1% (95% CI, 15.3-26.9%) were admitted or transferred. Among patients 91 days to <2 years in age, 6.8% (95% CI, 5.8-7.8%) had blood and 7.7% (95% CI 6.1-9.4%) had urine cultures; 40.5% (95% CI, 40.5-40.5%) were given antibiotics, and 4.4% (95% CI, 3.5-5.3%) were admitted or transferred. Patients 91 days to <2 years who were evaluated in general EDs had higher rates of radiography (27.1% vs 15.2%; P<0.01) and antibiotic utilization (42.3% vs 34.2%; P<0.01), but lower rates of urine culture testing (6.4% vs 11.6%, p = 0.03), compared with patients evaluated in pediatric EDs.
Approximately 180,000 patients ≤90 days old and 2.6 million patients 91 days to <2 years in age with fever present to US EDs annually. Given existing guidelines, blood and urine culture performance was low for infants ≤90 days old. For children 91 days to <2 years, rates of radiography and antibiotic use were higher in general EDs compared to pediatric EDs. These findings suggest opportunities to improve care among febrile young children in the ED.
本研究的目的是估计2岁以下儿童因发热前往急诊科（ED）就诊的比率，并评估这些就诊期间的检查和治疗频率。
我们使用美国国家医院门诊医疗调查对2007年至2017年急诊科的就诊情况进行了横断面研究，这是一项对美国非联邦急诊科就诊情况的横断面、多阶段概率抽样调查。我们纳入了就诊原因是“发热”或在急诊科记录有发热的就诊情况。我们报告了两组人群的人口统计学和管理策略：年龄≤90天的婴儿；以及91天至未满2岁的儿童。对于91天至未满2岁的患者，我们使用卡方检验比较了综合急诊科和儿科急诊科之间的检查和治疗策略。
在11年的15亿次就诊中，2.1%（95%置信区间[CI]，1.9 - 2.2%）是2岁以下发热儿童的就诊。200万次就诊（95% CI，170万 - 240万）是年龄≤90天的婴儿，2840万次就诊（95% CI，2550万 - 3140万）是91天至未满2岁的儿童。在年龄≤90天的婴儿中，27.6%（95% CI，21.1 - 34.1%）进行了血液检查，21.3%（95% CI，13.6 - 29.1%）进行了尿液培养；26.8%（95% CI，20.9 - 32.7%）接受了抗生素治疗，21.1%（95% CI，15.3 - 26.9%）被收治或转诊。在91天至未满2岁的患者中，6.8%（95% CI，5.8 - 7.8%）进行了血液检查，7.7%（95% CI，6.1 - 9.4%）进行了尿液培养；40.5%（95% CI，40.5 - 40.5%）接受了抗生素治疗，4.4%（95% CI，3.5 - 5.3%）被收治或转诊。与在儿科急诊科接受评估的患者相比，在综合急诊科接受评估的91天至未满2岁的患者进行影像学检查的比率更高（27.1%对15.2%；P < 0.01），抗生素使用率更高（42.3%对34.2%；P < 0.01），但尿液培养检查比率更低（6.4%对11.6%，p = 0.03）。
美国急诊科每年约有180,000名年龄≤90天的患者和260万名年龄为91天至未满2岁的发热患者就诊。根据现有指南，年龄≤90天的婴儿进行血液和尿液培养的比例较低。对于91天至未满2岁的儿童，综合急诊科的影像学检查和抗生素使用比率高于儿科急诊科。这些发现表明在急诊科改善发热幼儿护理方面存在机会。
