{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:05:17Z","timestamp":1789610717008,"version":"build-2803163510"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>The Pediatric Emergency Care Applied Research Network (PECARN) prediction rule identifies febrile infants at low risk for serious bacterial infection (SBI). However, its impact on avoidable interventions in the emergency department remains unknown.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Objective<\/jats:title>\n            <jats:p>To study the impact on lumbar puncture (LP) performance, empiric antibiotic use, and admissions after implementing a febrile infant clinical practice guideline for infants aged 29 to 60 days based on the PECARN prediction rule in the pediatric emergency department.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This single center preintervention to postintervention study included infants 29 to 60 days old who presented with a chief complaint of fever from November 2018 to November 2021 and were assessed for SBI via blood culture and either urinalysis or urine culture. A new clinical practice guideline based on the PECARN prediction rule was implemented on December 2019. Lumbar puncture attempts, antibiotic administration, and admissions were compared preimplementation and postimplementation and in subgroups of low- and high-risk patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Of 1597 (PRE: 785, POST: 812) infants presenting with fever, 1032 (PRE: 500, POST: 532) met inclusion criteria. Adoption of guideline recommendations (measured as procalcitonin order rate) was 89.7% in eligible infants postimplementation. Overall, there was a significant decrease in LPs (PRE: 30.6%, POST: 22.6%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05) and no significant change in antibiotics or admissions. Among low-risk infants, there was a significant reduction in LPs (PRE: 17.2%, POST: 4.4%, <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05) and antibiotics (PRE: 14.5%, POST: 4.1%; <jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05). There was no change in missed SBI (PRE: 3, POST: 2, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.65). No cases of missed meningitis preimplementation or postimplementation were observed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>After implementation of a guideline based on the PECARN prediction rule, we observed a reduction of LPs and antibiotics in low-risk infants. Overall, a decrease in LPs was observed, whereas antibiotic use and admissions remained unchanged.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000002905","type":"journal-article","created":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T16:12:49Z","timestamp":1696003969000},"page":"739-743","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Impact on Emergency Department Interventions After Implementing a Guideline Based on the Pediatric Emergency Care Applied Research Network Prediction Rule for Identifying Low-Risk Febrile Infants 29 to 60 Days Old"],"prefix":"10.1097","volume":"39","author":[{"given":"Gargi","family":"Mukherjee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evan","family":"Orenstein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shabnam","family":"Jain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Hames","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2023,1,21]]},"reference":[{"key":"bib1-20250504","first-page":"146","article-title":"United States' emergency department visits for fever by young children 2007\u20132017","volume":"21","year":"2020","journal-title":"West J Emerg Med"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1067\/mem.2000.110820","article-title":"Management of fever without source in infants and children","volume":"36","year":"2000","journal-title":"Ann Emerg Med"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1542\/peds.2014-1382","article-title":"Variation in care of the febrile young infant <90 days in US pediatric emergency departments","volume":"134","year":"2014","journal-title":"Pediatrics"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/INF.0000000000000225","article-title":"The changing epidemiology of serious bacterial infections in young infants","volume":"33","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"e20170476","DOI":"10.1542\/peds.2017-0476","article-title":"The epidemiology, management, and outcomes of bacterial meningitis in infants","volume":"140","year":"2017","journal-title":"Pediatrics"},{"key":"bib6-20250504","doi-asserted-by":"crossref","first-page":"849","DOI":"10.1097\/INF.0000000000002346","article-title":"Epidemiology of serious bacterial infections in infants less than 90 days in a military health system cohort","volume":"38","year":"2019","journal-title":"Pediatr Infect Dis J"},{"key":"bib7-20250504","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1016\/j.jpeds.2018.04.033","article-title":"Epidemiology and etiology of invasive bacterial infection in infants \u226460 days old treated in emergency departments","volume":"200","year":"2018","journal-title":"J Pediatr"},{"key":"bib8-20250504","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.jemermed.2019.03.003","article-title":"Practice variation in the evaluation and disposition of febrile infants \u226460 days of age","volume":"56","year":"2019","journal-title":"J Emerg Med"},{"key":"bib9-20250504","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1542\/peds.2009-1070","article-title":"Performance of low-risk criteria in the evaluation of young infants with fever: review of the literature","volume":"125","year":"2010","journal-title":"Pediatrics"},{"key":"bib10-20250504","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/S0022-3476(85)80175-X","article-title":"Identification of infants unlikely to have serious bacterial infection although hospitalized for suspected sepsis","volume":"107","year":"1985","journal-title":"J Pediatr"},{"key":"bib11-20250504","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1542\/peds.94.3.390","article-title":"Febrile infants at low risk for serious bacterial infection\u2014an appraisal of the Rochester criteria and implications for management. 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