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New Study Suggests that Clinical Guidelines Used to Treat Infants with Fevers May Not Improve Outcomes

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Press Release Date: March 9, 2004

Experienced pediatricians who relied on their clinical judgment more than existing clinical guidelines were able to minimize hospitalizations and avoid unnecessary lab testing for infants with fevers without a negative impact on the outcomes of care, according to a new study supported by the Agency for Healthcare Research and Quality. The study, "Management and Outcomes of Care of Fever in Early Infancy," is published in the March 10 issue of the Journal of the American Medical Association.

Underlying conditions associated with fever symptoms in infants are difficult to recognize and range from minor illnesses to those that are life threatening. Expensive strategies that include hospitalization, extensive laboratory testing and intravenous antibiotics have traditionally been used for diagnosis and treatment of infants with fever to protect against bacterial meningitis and bacterial blood infections, illnesses that affect approximately 2 to 3 percent of infants with fevers.

Researchers, led by University of California, San Francisco's Robert H. Pantell, M.D., worked with more than 573 clinician's offices in 44 states that were part of the American Academy of Pediatrics' Pediatric Research in Office Settings Network from 1995 to 1998. The more than 3,000 infants in the study were 3 months or younger and had no health problems other than a fever of at least 100.4° F. At that time, clinical practice guidelines for treating infants with fevers recommended that all infants under 1 month of age be hospitalized and treated with antibiotics and that laboratory tests be routinely performed on all infants less than 3 months. This remains the current standard of care.

Researchers found that clinicians followed clinical practice guidelines to treat infants with fevers 42 percent of the time. Clinicians performed lab tests in 75 percent of the infants and treated 57 percent with antibiotics. In the first month of life, 40 percent fewer infants were hospitalized when clinicians did not follow guidelines. Rather than hospitalization, the clinicians saw many infants in repeated office visits and had frequent telephone followup. The infants who were treated in the office and with followup visits experienced similar results to those that would have been treated following the guidelines.

"While clinical guidelines are an important part of everyday practice, they are only one element of the foundation of evidence available to clinicians," said AHRQ Director Carolyn M. Clancy, M.D. "Clinicians should rely on their training and judgment and work closely with parents to tailor evidence-based recommendations to patients' needs."

For more information, please contact AHRQ Public Affairs: Kristie Smith, (301) 427-1246 (; Karen Migdail (301) 427-1855 (


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