Management of Febrile Infants in a Rural Hospital: Comparison to Clinical Guidelines
Abstract
OBJECTIVE
Primary: To evaluate adherence to statewide guidelines for managing fever in infants < 90 days old presenting to rural hospital EDs in southern NSW. Comparisons were made between level 1-2 and level 4 rural hospitals. Secondary: To assess the utility of laboratory markers in differentiating bacterial from viral infections.
DESIGN
Retrospective observational study.
SETTING
Wagga Wagga Base Hospital, a regional centre in NSW, Australia.
PARTICIPANTS
One hundred thirty-four febrile children aged 0-90 days.
MAIN OUTCOME MEASURES
Adherence to guideline-recommended investigations (basic bloods, blood culture, urine culture, lumbar puncture) and management (antibiotics, time to antibiotics). Positive predictive values of CRP, white cell count (WCC) and neutrophil count for serious bacterial infections (SBIs) were calculated.
RESULTS
Guideline adherence: blood tests 79%, blood culture 79%, urine culture 76%, lumbar puncture 56% and parenteral antibiotics 83%. Adherence to blood/urine cultures was higher in the < 1 month age group than the 30-90 day age group. Investigations and management at level 1-2 hospitals were similar to the level 4 hospital, except regarding urine cultures in the < 1 month old age group. We observed higher CRP levels in infants diagnosed with SBIs compared to those without.
CONCLUSION
Management of febrile infants < 90 days in southern NSW rural hospitals aligns well with guidelines, except for lumbar punctures in infants < 1 month. Level 1-2…
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