Emergency department versus office setting and physician/patient kinship effects in the diagnostic and therapeutic choices of febrile children at risk for occult bacteremia.

Abstract

BACKGROUND: Given the controversy of selecting a diagnostic and treatment approach for the febrile child at risk for occult bacteremia, the purpose of this study is to survey the diagnostic and treatment strategies chosen by pediatricians for a febrile child at risk for occult bacteremia seen in three different settings (private office, emergency department, their own child) to see if any differences exist. STUDY DESIGN: Survey of pediatricians given a case scenario of a febrile female child without a source of the fever presenting in three different clinical settings: 1) Office. 2) Emergency Department (E.D.). 3) Pediatrician's daughter. RESULTS: 138 pediatrician surveys were tabulated. Pediatricians ordered the most tests and empiric antibiotic treatments in the E.D., the fewest tests and empiric antibiotic treatments on their daughter, and intermediate frequency of tests and empiric antibiotic treatments in the office. Roughly half the pediatricians ordered the same level of tests in all three clinical settings, while the other half varied their test ordering in the different clinical settings. CONCLUSION: The clinical setting has an effect on the diagnostic and treatment strategies chosen when evaluating a febrile child at risk for occult bacteremia with patients seen in the E.D. receiving more laboratory tests and antibiotic treatment compared to office patients. Kinship also has an effect, with a child (daughter in this instance) of a pediatrician receiving the fewest laboratory tests and antibiotic treatment.