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The Kern Fever in the Emergency Department Study (Kern FEDS): Clinical appearance, serious bacterial illness, and the meaning of uncertainty

Background: Emergency department (ED) fever management algorithms require the clinician to categorize febrile children as ‘ill’ or ‘not ill’ appearing when determining the risk for serious bacterial illness (SBI). This study describes a natural experiment where an ED pediatric chart allowed clinicia...

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Bibliographic Details
Published in:PeerJ preprints 2014-10
Main Authors: Walsh, Paul, Capote, Allan, Garcha, Davinder, Nguyen, Vu, Sanchez, Yvette, Mendoza, Nanse, Thabit, Christina, Aguilar, Valerie, Pusavat, James
Format: Article
Language:English
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Summary:Background: Emergency department (ED) fever management algorithms require the clinician to categorize febrile children as ‘ill’ or ‘not ill’ appearing when determining the risk for serious bacterial illness (SBI). This study describes a natural experiment where an ED pediatric chart allowed clinicians a third option, ‘unsure’. Hypotheses: We hypothesized (1) that chart prompts would improve documentation of clinical appearance, and (2) that exam findings and prevalence of serious bacterial illness in infants categorized as ‘unsure’ would be intermediate between those who were ill and not ill appearing. Design: We conducted a retrospective study of 3005 ED patients aged 0-24 months who had microbiology testing for fever in the ED between 1/1/2006 and 11/30/2009. We modeled overall appearance as the dependent and individual physical findings as the independent variables with ordinal logistic regression to help establish the validity of clinical appearance as a concept. We then compared the prevalence of the components of SBI, bacterial meningitis, pneumonia, urinary tract infection (UTI) and positive blood cultures, between the categorizations, not ill appearing, unsure and ill appearing. Results: Clinical appearance was documented in 60/583 (10.3%) whose encounter was recorded on the template without prompts versus 2036/2420 (84%) with prompts (p
ISSN:2167-9843
DOI:10.7287/peerj.preprints.527v1