THE MANAGEMENT OF FEBRILE INFANTS BY PRIMARY-CARE PEDIATRICIANS IN UTAH - COMPARISON WITH PUBLISHED PRACTICE GUIDELINES

Objective. To determine primary-care pediatricians' management of febr ile infants and compare them with published practice guidelines. Desig n. Case scenarios were sent to 194 primary-care pediatricians in Utah, describing three febrile infants, ages 21 days, 60 days, and 20 month s, corresponding to the three age groups: 0 to 28 days; 29 to 90 days, and 91 days to 36 months for which the guidelines suggest different s trategies. Results. Ninety-four pediatricians responded (response rate , 48%). Compliance with the guidelines was 39% for the 21 day old, 9.6 % for the 60 day old, and 75% for the 20 month old. No respondent foll owed the guidelines for ah three infants. Performance of tests to dete rmine if an infant was low risk varied from 3%, for a stool white cell examination in a febrile 2 month old with diarrhea, to 75% for a comp lete blood count in a 20 month old with a temperature of 40 degrees C. Compliance did not differ between private and academic practitioners. Those in practice less than 5 years (n = 22) were more likely than th ose with more experience to follow the guidelines for the 21 day old b ut not the other two infants. Conclusion. Primary-care pediatricians i n Utah manage febrile infants with fewer laboratory tests and less hos pitalization than recent practice guidelines developed by an expert pa nel of academic specialists suggest.