Management of febrile infants and children by pediatric emergency medicineand emergency medicine: Comparison with practice guidelines

Objectives: Management of febrile infants and children remains controversia l despite the 1993 publication in Pediatrics and Annals of Emergency Medici ne of practice guidelines. Our aim was to determine the management of febri le infants and children by pediatric emergency medicine (PEM) fellowship di rectors and emergency medicine (EM) residency directors and compare their a pproach with the published practice guidelines. Methods: Four case scenarios were sent to 64 PEM directors and 100 EM direc tors in the United States and Canada, describing four febrile, nontoxic inf ants and children aged 25 days (case 1), 7 weeks (case 2), 5 months (case 3 ), and 22 months (case 4), Respondents were asked to select which laborator y tests and radiographs they mould obtain and to decide on treatment and di sposition for each hypothetical case. Results: Ninety-two percent (53/61) of PEM directors and 64% (64/100) of EM directors responded (overall response rate 74%), Compliance with the guide lines (PEM/EM) was 54%/16% for case 1, 31%/6470 for case 2, 35%/19% for cas e 3, and 20%/11% for case 4. Only 11% of PEM and 2% of EM directors followe d the guidelines for all four cases. Overall, directors performed fewer lab oratory tests, ordered more chest radiographs and treated fewer patients wi th antibiotics than the expert panel suggested. EM directors ordered more c hest radiographs (cases 1-4) and admitted more patients (case 2) than PEM d irectors. Conclusions: There is poor compliance with published practice guidelines in the management of febrile infants and children among PEM and EM directors.