title: Charges and complications associated with the medical evaluation of febrile young infants.
abstract: BACKGROUND
  Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days.
  
  
  METHODS
  A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period after a retrospective pilot study. One investigator (C.C.) followed the medical course of enrolled FYIs, including 3 standardized scheduled phone follow-ups with the subject's parent and primary care provider (PCP) within the 2 weeks after discharge.
  
  
  RESULTS
  Sixty-two subjects were enrolled during the 16-month period (58 admitted and 4 discharged subjects). Two (3%) subjects who met low-risk criteria developed a serious bacterial infection, both urinary tract infections. No cases of true bacteremia or bacterial meningitis were diagnosed. Seventeen subjects (29.3%) developed a complication during the admission. The mean length of inpatient stay was 49.0 hours (range, 18.1-65.4 hours). The mean charge for hospitalization was $6202 (range, $2818-$9880). Scheduled phone follow-up was successful on days 2 (77.4%), 7 (85.4%), and 14 (83.9%) after discharge. All patients were reported as improved (100%), and most parents preferred discharge to admission (66%-70%). In the 2 weeks after discharge, only 45 (72.6%) of 62 subjects had followed up with their PCPs.
  
  
  CONCLUSIONS
  This prospective quality indicator/quality assurance study demonstrates that inpatient evaluation of low-risk FYIs results in high charges and potentially preventable complications. Hospitalization is contrary to the wishes of most parents in this study; however, the rate of appropriate follow-up with a PCP in this study is concerning.
authors.affiliation: Division of Emergency Medical Services, Department of Pediatrics,Children's Mercy Hospital, Kansas City, MO 64108, USA. cscondra@cmh.edu
authors.forename: Cole S
authors.initials: CS
authors.lastname: Condra
authors.forename: Beena
authors.initials: B
authors.lastname: Parbhu
authors.forename: Douglas
authors.initials: D
authors.lastname: Lorenz
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Herr
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001424:Bacterial Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000191:economics; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000191:economics* / Q000209:etiology; D005500:Follow-Up Studies; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007629:Kentucky; D007902:Length of Stay / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013689:Telephone; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents