title: Association between Clinical Outcomes and Hospital Guidelines for Cerebrospinal Fluid Testing in Febrile Infants Aged 29-56 Days.
abstract: OBJECTIVE
  To describe the association between clinical outcomes and clinical practice guidelines (CPGs) recommending universal cerebrospinal fluid (CSF) testing in the emergency department for febrile infants aged 29-56 days.
  
  
  METHODS
  Using 2007-2013 administrative data from 32 US children's hospitals, we performed a difference-in-differences analysis comparing 7 hospitals with CPGs recommending universal CSF testing for older febrile infants aged 29-56 days (CPG group) with 25 hospitals without such CPGs (control group). We compared differences in clinical outcomes between older febrile infants with the corresponding differences among younger febrile infants aged 7-28 days. The primary outcome was the occurrence of an adverse event, defined as a delayed diagnosis of bacterial meningitis, mechanical ventilation, placement of a central venous catheter, extracorporeal membrane oxygenation, or in-hospital mortality. Analyses were adjusted for race/ethnicity, sex, median annual household income by zip code, primary insurance source, discharge season, and discharge year.
  
  
  RESULTS
  The proportion of older febrile infants undergoing CSF testing was higher (P < .001) in the CPG group (64.8%) than the control group (47.8%). CPGs recommending universal CSF testing for older febrile infants were not associated with significant differences in adverse events (difference-in-differences: +0.31 percentage points, 95% CI -0.18 to 0.85; P = .22).
  
  
  CONCLUSIONS
  Hospital CPGs recommending universal CSF testing for febrile infants aged 29-56 days were not associated with significant differences in clinical outcomes.
authors.affiliation: Division of Emergency Medicine at Boston Children's Hospital, Boston, MA. Electronic address: kaopingchua@uchicago.edu.
authors.forename: Kao-Ping
authors.initials: KP
authors.lastname: Chua
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.affiliation: Department of Health Care Policy, Harvard Medical School, Boston, MA; Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: J Michael
authors.initials: JM
authors.lastname: McWilliams
authors.affiliation: Section of Emergency Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT.
authors.forename: Paul L
authors.initials: PL
authors.lastname: Aronson
mesh_terms: D002555:Cerebrospinal Fluid / Q000737:chemistry*; D004636:Emergency Service, Hospital; D005260:Female; D005334:Fever / Q000134:cerebrospinal fluid / Q000175:diagnosis* / Q000209:etiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014481:United States