Resource Utilization and Cost in Management of Febrile Infants After the 2021 Clinical Guideline.

Abstract

OBJECTIVE The 2021 American Academy of Pediatrics clinical practice guideline (CPG) for well-appearing febrile infants aims to promote evidence-based care, reduce practice variability, enhance care quality, and optimize cost. We aimed to examine the trends in resource utilization and cost associated with the evaluation and management of febrile infants aged 8 to 60 days before and after the CPG's publication. METHODS We performed a retrospective cross-sectional study using the Pediatric Health Information Systems Database, covering the periods of August 2019 to July 2021 (pre-CPG) and August 2021 to July 2023 (post-CPG). We analyzed the use of antibiotics, acyclovir, laboratory studies, lumbar punctures (LPs), and hospitalizations before and after the CPG publication. RESULTS We identified 33 736 encounters (12 220 pre-CPG and 21 516 post-CPG). After the CPG, there was a decrease in hospitalization (42.6% vs 34.7%, -7.9% [-9.0% to -6.8%]), antibiotic and acyclovir administration (41.9% vs 33.1%, -8.8% [-9.9% to -7.7%]; 9.7% vs 7.3%, -2.4% [-3.1% to -1.8%]), and LP (31.7% vs 21.8%, -9.9% [-10.9% to -8.9%]). Conversely, the use of C-reactive protein (23.7% vs 32.3%, 8.6% [7.6% to 9.5%]) and procalcitonin (40.1% vs 64.5%, 24.4% [23.3% to 25.5%]) increased. Cost remained unchanged. Age-stratified analysis revealed a significant reduction in hospitalization, antibiotic use, and LP in infants aged older than 22 days, whereas infants younger than 28 days experienced a slight increase in delayed diagnosis of bacteremia and sepsis after the CPG. CONCLUSIONS After the CPG, hospitalization, antimicrobial use, and LPs decreased in infants aged older than 22 days, indicating that the CPG may be effective in reducing resource utilization. There was a slight increase in delayed diagnosis of bacteremia and sepsis in infants younger than 28 days.