EMERGENCY DEPARTMENT AND INPATIENT CLINICAL DECISION TOOLS FOR THE MANAGEMENT OF FEBRILE YOUNG INFANTS AMONG TERTIARY PEDIATRIC CENTERS ACROSS CANADA
Bibliographic record
Abstract
Abstract BACKGROUND With no nationally endorsed guidelines and newer diagnostic tools, there exists widespread practice variation in the management of febrile infants <90 days. OBJECTIVES This study sought to evaluate the prevalence of clinical decision tools (CDTs) for the management of febrile young infants in the Emergency Department (ED) and inpatient settings among all tertiary paediatric centers across Canada. DESIGN/METHODS A cross-sectional, Internet-based survey was distributed to both an ED and an inpatient physician representative at each of the 16 Canadian tertiary paediatric centers. Participants were asked to characterize their clinical settings, diagnostic test availability and institutional febrile young infant CDTs. Copies were requested of all febrile infant-specific materials for independent classification as clinical pathway, guideline or order set, and content review using list items determined a priori. The primary analysis was the proportion of settings that use a CDT for the management of febrile infants. Chi-square testing was used to compare proportions. RESULTS Survey response rate was 100% (n = 32, 16 ED and 16 inpatient). Febrile young infant CDTs of any type were infrequently reported overall (9/32, 38%), and were more common in the ED than inpatient setting (50% vs. 6%, p=0.02). Prevalence of any CDT was not associated with hospital volume or physician training. Among EDs, clinical pathways, guidelines, and order sets were available at 6/16 (38%), 1/16 (6%), and 4/16 (25%) institutions, respectively. Among centers reporting existent CDTs, few reported ED or inpatient tracking of provider adherence or audits of impact (3/9, 33% overall). Review of existing CDTs revealed inter-center differences for inclusion ages, antibiotic treatment regimens, lumbar puncture recommendations, diagnostic testing and normal laboratory reference values. Despite wide availability reported at nearly all centers, C-reactive protein and respiratory viral testing were each rarely incorporated into existent CDTs (3/9, 33% for both). Procalcitonin testing was reported to be available at 2/16 (13%) centers, and was not incorporated into any existing CDTs. CONCLUSION CDTs for the management of febrile young infants are infrequently available among Canadian tertiary paediatric centers, and when present, rarely contain information on newer diagnostic tests. The paucity of CDTs among paediatric academic training centers may in part underlie ongoing practice variation. Heterogeneity among existent CDTs highlights the need for the establishment of updated and unified ED and inpatient national guidelines.
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 distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 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 teacher head, 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".