Variability in Hospital Admission Rates for Neonates With Fever in North Carolina

Background . Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient dispositio...

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Main Authors: Winston Wu MD, Katie Harmon PhD, Anna Estelle Waller ScD, Courtney Mann MD, FACEP, FAAP
Format: Article
Language:English
Published: SAGE Publishing 2019-07-01
Series:Global Pediatric Health
Online Access:https://doi.org/10.1177/2333794X19865447
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spelling doaj-36ad51c93e014094b386d63547ce07892020-11-25T03:35:04ZengSAGE PublishingGlobal Pediatric Health2333-794X2019-07-01610.1177/2333794X19865447Variability in Hospital Admission Rates for Neonates With Fever in North CarolinaWinston Wu MD0Katie Harmon PhD1Anna Estelle Waller ScD2Courtney Mann MD, FACEP, FAAP3University of North Carolina at Chapel Hill, NC, USAUniversity of North Carolina at Chapel Hill, NC, USAUniversity of North Carolina at Chapel Hill, NC, USAUniversity of North Carolina at Chapel Hill, NC, USABackground . Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient disposition in such cases within North Carolina. Methods . This study is a retrospective cohort study of infants 1 to 28 days old with a diagnosis of fever presenting to North Carolina EDs from October 1, 2010, to September 30, 2015, using data from the NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) database. We analyzed various patient epidemiology characteristics and their associations with patients being admitted or discharged from the emergency room setting. Results . Of 2745 unique patient visits for neonatal fever, 1173 (42.7%) were discharged from the ED, while 1572 (57.3%) were either admitted or transferred for presumed admission. Age, sex, region within North Carolina, and the presence of a pediatric service did not significantly influence disposition. An abnormal documented ED temperature was associated with higher likelihood of admission ( P < .01). The size of the hospital was also found to be significant when comparing large with small hospitals ( P < .01). Government-funded insurance was associated with lower likelihood of admission ( P < .01). Conclusions . A high number of neonates diagnosed with fever were discharged home, inconsistent with current recommendations. An association with a government-funded insurance represents a possible health care disparity. Further studies are warranted to further understand these variations in practice.https://doi.org/10.1177/2333794X19865447
collection DOAJ
language English
format Article
sources DOAJ
author Winston Wu MD
Katie Harmon PhD
Anna Estelle Waller ScD
Courtney Mann MD, FACEP, FAAP
spellingShingle Winston Wu MD
Katie Harmon PhD
Anna Estelle Waller ScD
Courtney Mann MD, FACEP, FAAP
Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
Global Pediatric Health
author_facet Winston Wu MD
Katie Harmon PhD
Anna Estelle Waller ScD
Courtney Mann MD, FACEP, FAAP
author_sort Winston Wu MD
title Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
title_short Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
title_full Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
title_fullStr Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
title_full_unstemmed Variability in Hospital Admission Rates for Neonates With Fever in North Carolina
title_sort variability in hospital admission rates for neonates with fever in north carolina
publisher SAGE Publishing
series Global Pediatric Health
issn 2333-794X
publishDate 2019-07-01
description Background . Despite multiple guidelines recommending admission, there is significant variation among emergency departments (EDs) regarding disposition of neonates presenting with fever. We performed a statewide epidemiologic analysis to identify characteristics that may influence patient disposition in such cases within North Carolina. Methods . This study is a retrospective cohort study of infants 1 to 28 days old with a diagnosis of fever presenting to North Carolina EDs from October 1, 2010, to September 30, 2015, using data from the NC DETECT (North Carolina Disease Event Tracking and Epidemiologic Collection Tool) database. We analyzed various patient epidemiology characteristics and their associations with patients being admitted or discharged from the emergency room setting. Results . Of 2745 unique patient visits for neonatal fever, 1173 (42.7%) were discharged from the ED, while 1572 (57.3%) were either admitted or transferred for presumed admission. Age, sex, region within North Carolina, and the presence of a pediatric service did not significantly influence disposition. An abnormal documented ED temperature was associated with higher likelihood of admission ( P < .01). The size of the hospital was also found to be significant when comparing large with small hospitals ( P < .01). Government-funded insurance was associated with lower likelihood of admission ( P < .01). Conclusions . A high number of neonates diagnosed with fever were discharged home, inconsistent with current recommendations. An association with a government-funded insurance represents a possible health care disparity. Further studies are warranted to further understand these variations in practice.
url https://doi.org/10.1177/2333794X19865447
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