Abstract
Our goal in this study was to estimate rates of emergency department (ED) visits for fever by children <2 years of age, and evaluate frequencies of testing and treatment during these visits. we performed a cross-sectional study of ed encounters from 2007-2017 using the national hospital ambulatory medical care survey, a cross-sectional, multi-stage probability sample survey of visits to nonfederal united states eds. we included encounters with a visit reason of "fever" or recorded fever in the ed. we report demographics and management strategies in two groups: infants ≤90 days in age; and children 91 days to><2 years old. for patients 91 days to><2 years, we compared testing and treatment strategies between general and pediatric eds using chi-squared tests. of 1.5 billion encounters over 11 years, 2.1% (95% confidence interval [ci], 1.9-2.2%) were by children><2 years old with fever. two million encounters (95% ci, 1.7-2.4 million) were by infants ≤90 days, and 28.4 million (95% ci, 25.5-31.4 million) were by children 91 days to><2 years. among infants ≤90 days, 27.6% (95% ci, 21.1-34.1%) had blood and 21.3% (95% ci, 13.6-29.1%) had urine cultures; 26.8% (95% ci, 20.9-32.7%) were given antibiotics, and 21.1% (95% ci, 15.3-26.9%) were admitted or transferred. among patients 91 days to><2 years in age, 6.8% (95% ci, 5.8-7.8%) had blood and 7.7% (95% ci 6.1-9.4%) had urine cultures; 40.5% (95% ci, 40.5-40.5%) were given antibiotics, and 4.4% (95% ci, 3.5-5.3%) were admitted or transferred. patients 91 days to><2 years who were evaluated in general eds had higher rates of radiography (27.1% vs 15.2%; p><0.01) and antibiotic utilization (42.3% vs 34.2%; p><0.01), but lower rates of urine culture testing (6.4% vs 11.6%, p="0.03)," compared with patients evaluated in pediatric eds. approximately 180,000 patients ≤90 days old and 2.6 million patients 91 days to><2 years in age with fever present to us eds annually. given existing guidelines, blood and urine culture performance was low for infants ≤90 days old. for children 91 days to><2 years, rates of radiography and antibiotic use were higher in general eds compared to pediatric eds. these findings suggest opportunities to improve care among febrile young children in the ed.>
