OGDEN -- A new approach to evaluating fever in infants promises a faster, more accurate diagnosis and treatment and is expected to save millions of dollars in the long run.
A study conducted by Intermountain Healthcare hospitals, in conjunction with the University of Utah Department of Pediatrics, is the first to show that evidence-based care improves outcomes at lower costs, say researchers, which included physicians in the Ogden area who admit and treat children at McKay-Dee Hospital.
"This is the largest study ever conducted in the United States on the care of infants with fever," said Dr. Carrie L. Byington, University of Utah professor of pediatrics and principal investigator of the study.
The model for treating infants with fever was developed at Primary Children's Medical Center in Salt Lake City.
Guidelines for treatment implemented at some Intermountain hospitals, including McKay-Dee, included obtaining a complete blood count and urinalysis for all infants with fever, and viral diagnostic testing for all infants with fever being admitted to the hospital.
The model also includes treatment and discharge guidelines based on those tests.
According to the study, published in the July 1, edition of Pediatrics, this approach has proven better outcomes and, in 2009 alone, saved four hospitals, including McKay-Dee, $1.9 million.
"This study helped us narrow down much more clearly and scientifically who needed what test, who needed antibiotics and who didn't, and who was safe to send home and when," said Dr. Christine Nefcy, chief medical officer and former chief of pediatrics at McKay-Dee.
"There was variability in our management of infants with fevers, depending on your training and where you studied medicine. We were very conservative in our approach, which meant most babies who had fever had lots of tests done, received antibiotics and often other medicines and stayed in the hospital so that we could be really sure that we didn't miss anything."
Fever is a common problem in young infants, researchers say. During the study period -- from 2004 to 2009 -- 8,044 infants with fever were evaluated at Intermountain Healthcare facilities.
Following implementation of the care model, infants with serious bacterial infections were more likely to be recognized and admitted at the initial evaluation, ensuring treatment began quickly, the study showed.
In addition, infants with viral infections were less likely to get unnecessary antibiotics, hospital stays decreased from 60 hours to 44, amounting to 1,644 fewer days spent in the hospital, and hospital costs decreased by more than $1,000 per infant admission.
"The results of this study allow us to provide optimal care in the emergency department and at the same time to lower costs. It also provides shorter, more positive hospital stays for the infants and parents," said Dr. Brent Wallace, chief medical officer of Intermountain Healthcare.
Nefcy said doctors get very concerned about infants younger than 90 days who develop a fever of 100.4 degrees or higher.
"Because their immune systems aren't as mature as an older infant or child, they can get sick much faster and more seriously," she said.
"The vast majority of the time, they have a relatively benign illness, like the common cold, that they get from an older sibling or another family member."
But sometimes they have a more serious illness, such as flu or pertussis. In those cases, Nefcy said, doctors wants to know as early as possible so the infant can get the appropriate treatment as quickly as possible.
"This study is a big step in the right direction on many levels," she said.
"It uses scientific evidence to provide clinicians clear guidance to use in their practice, it saves money for both patients and hospitals, but most importantly, it provides our young pediatric patients with the best possible care and outcomes."