18: Perceived Utility of Respiratory Virus Testing for Febrile Infants Under Six-Weeks of Age Among Canadian Pediatric Emergency and Inpatient Physicians
Bibliographic record
Abstract
Well appearing febrile infants with viral illnesses cannot be easily distinguished from those with occult life-threatening infections by history and physical exam alone. This national practice variation study sought to assess current approaches to febrile infants under 6-weeks of age, and determine how management is influenced by respiratory virus testing. A scenario-based survey describing two hypothetical cases of febrile infants without a focus aged 3- and 5-weeks was sent to ED and inpatient physicians at all of the 15 tertiary pediatric centers across Canada. Participants were asked multiple-choice questions regarding management decisions with and without results of respiratory virus testing. χ2 testing was used to compare proportions. Response rate was 78% (n=329; 190 ED physicians, 139 inpatient physicians). Investigations most commonly performed for both 3- and 5-week old infants were urine culture, urine analysis, CBC and blood culture. Lumbar puncture was performed less frequently in 5-week old infants (49% vs. 93%, P<0.0001). Conversely, respiratory virus testing was performed more frequently among 3-week old infants (46% vs. 34%, P<0.05). Older infant age decreased rate of admission, however detection of a respiratory virus further reduced admissions among both 3-week (83% vs. 95%, P<0.001) and 5-week old infants (36% vs. 52%, P<0.001). Similarly, empiric antibiotic treatment was initiated less frequently in older infants, and was further reduced by detection of a respiratory virus among both 3-week (65% vs. 92%, P<0.001) and 5-week old infants (25% vs. 39%, P<0.001). Inpatient physicians were more likely than ED physicians to admit (68% vs. 41%, P<0.001) and start antibiotic therapy (52% vs. 30%, P<0.001) in 5-week old infants. Among inpatient physicians, 81% would discharge 5-week old infants in ≤24 h with a detectable respiratory virus and otherwise negative workup; whereas admission duration among 3-week old infants was highly variable. The management of febrile infants under 6-weeks differs between ED and inpatient physicians, and by infant age. Respiratory virus testing could potentially reduce admissions and empirical antimicrobial treatment, as well as permit earlier discharge. Establishment of clinical guidelines for this patient population is warranted.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".