Comparative practice patterns of emergency medicine physicians and pediatric emergency medicine physicians managing fever in young children

Background/Objective. The management of fever in young children is a contro versial topic. This study seeks to compare the management approaches betwee n general emergency medicine physicians (GEMPs) and pediatric emergency med icine physicians (PEMPs) and correlate them to existing practice guidelines . Design/Methods. All charts of children age 3 to 36 months presenting with t he complaint of fever at both a children's hospital emergency department (E D) and a general ED from June 1, 1998 to September 1, 1998; December 1, 199 8 to April 1, 1999; and June 1, 1999 to September 1, 1999 were retrospectiv ely reviewed. Fever was defined as greater than or equal to 39 degrees C. P atients with a history of immunodeficiency, chronic illness, ventriculoperi toneal shunt, antibiotic use in the past 48 hours, or focal infection noted on examination were excluded. Data collected included focal exam findings, laboratory tests, diagnosis, treatment, and disposition. Variances from th e practice guidelines were tabulated and compared. Results. One thousand three hundred twenty-three eligible children met excl usion criteria and were seen by PEMPs; 755 were eliminated because of exclu sion criteria (526 because of focal infection). Twenty-two (4%) of 568 rema ining patients were admitted to the hospital. Two hundred twenty-eight elig ible children were seen by GEMPs; 147 were excluded (109 because of focal i nfection). No patients were admitted to the hospital. PEMPs ordered more co mplete blood counts (324/568 vs 27/81), more blood cultures (321/568 vs 27/ 81), and more urine cultures (208/568 vs 20/81) than GEMPs. GEMPs ordered m ore chest radiographs and cerebrospinal fluid analyses than PEMPs; GEMPs or dered less complete blood counts, blood cultures, and urine cultures than P EMPs. GEMPs diagnosed more focal infections (109/228 vs 526/1323), and conf licted more often with the practice guidelines (66/79 vs 225/498) than PEMP s. Patients spent an average of 2.26 +/- 0.16 hours in the pediatric ED ver sus 3.0 hours +/- 0.18 hours in the general ED. Conclusions. Significant differences in the management of the young child w ith fever and no source exist between these two groups of physicians. These variations affect both cost and standard of care. Future studies assessing whether these strategies affect patient outcomes would further elucidate t heir clinical implication.