title: Adherence to guidelines for managing the well-appearing febrile infant: assessment using a case-based, interactive survey.
abstract: OBJECTIVE
  The objectives of the study were (1) to determine the relative use of strategies for managing the well-appearing febrile infant and (2) to determine clinician adherence to protocol recommendations.
  
  
  METHODS
  Members of the American Academy of Pediatrics Section on Emergency Medicine were asked to complete an online, interactive, case-based questionnaire. Infants with a temperature of 38.6°C who were otherwise completely well were presented. Respondents ordered laboratory studies and received results. Treatment and disposition decisions based on those results were queried. Clinicians reported which published set of guidelines they followed. Major discriminating features of guidelines were used to assess adherence.
  
  
  RESULTS
  Two hundred ninety-nine (30%) clinicians completed the survey. The relative use of the 3 main guidelines was as follows: Philadelphia, 20%; Rochester, 15%; and Boston, 13%. Of respondents reporting that their practice is based on the Rochester criteria, 98% performed a lumbar puncture, 86% administered antibiotics, and 93% admitted the 25-day-old infant to the hospital, despite recommendations that a lumbar puncture was unnecessary and that the infant be managed as an outpatient without antibiotics. Similar deviations were seen among respondents who reported using the other criteria.Many respondents treated the infants with antibiotics, without obtaining cerebrospinal fluid for culture, despite recommendations against this practice.
  
  
  CONCLUSIONS
  Although most physicians report following published guidelines for the management of the well-appearing febrile infant, compliance with recommendations is poor. The effect that deviating from the guidelines has on patient outcome is unknown. Despite recommendations to the contrary, many physicians administer antibiotics without obtaining cerebrospinal fluid for culture.
authors.affiliation: Division of Emergency Medicine, Children's Hospital Boston, Harvard Medical School, Boston, MA 02115, USA. william.meehan@childrens.harvard.edu
authors.forename: William Paul
authors.initials: WP
authors.lastname: Meehan
authors.forename: Eric
authors.initials: E
authors.lastname: Fleegler
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003625:Data Collection; D003955:Diagnostic Tests, Routine; D004635:Emergency Medicine; D005334:Fever / Q000175:diagnosis / Q000628:therapy*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010343:Patient Admission; D010372:Pediatrics; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011364:Professional Practice; D012955:Societies, Medical; D013129:Spinal Puncture; D011795:Surveys and Questionnaires; D019564:Unnecessary Procedures
chemical_list: D000900:Anti-Bacterial Agents