ED survey reveals pattern of testing for fever without source

Simon AE. Pediatrics. 2011;128:e1368-e1375.

Physicians do not order diagnostic tests in most ED visits in the United States for fever without source among children aged 3 to 36 months, according to study results published online. However, being female, having a higher fever and higher median income of the patient’s ZIP code contributed to physicians ordering complete blood counts and urinalysis.

Alan E. Simon, MD, of the CDC’s National Center for Health Statistics, and colleagues used the 2006-2008 National Hospital Ambulatory Medical Care Survey–Emergency Department to identify visits by 3- to 36-month-old children with fever without source. The researchers also calculated the percentages of visits that included a complete blood count (CBC), urinalysis, blood culture, radiograph, rapid influenza test, admission to hospital, and ceftriaxone and other antibiotic administration.

“Although many studies have aimed to understand optimal management, few have focused on actual physician management patterns of children with [fever without source],” the researchers wrote. “Studies have surveyed practitioners and asked (by using vignettes) how they would approach a child with [fever without source], but physician report of practice preferences might not accurately reflect actual practice.”

According to the researchers, no tests were ordered in 58.6% of visits for fever without source, whereas CBCs were ordered in 20.5% of visits and urinalysis in 17.4% of visits. Physicians ordered a urinalysis in fewer than half of the visits by girls with a temperature of at least 39·C. Girls and boys with higher temperatures were more likely to receive a CBC and urinalysis, although girls were more likely than boys to receive CBCs and urinalyses. However, even among girls with a temperature of at least 39·C, urinalysis was ordered in only 40.2% of visits. Ceftriaxone was given in 7.1% and other antibiotics in 18.3% of visits; 5.2% of the children at these visits were admitted to the hospital.

Researchers found that although physicians ordered no tests for most of ED visits in the United States for fever without source among children aged 3 to 36 months, “antibiotics are still used with some frequency, including 20% of visits for [fever without source] in which no testing was conducted, which indicates potential overuse of antibiotics.”

Disclosure: The researchers report no relevant financial disclosures.

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