ASSESSMENT OF FEBRILE INFANTS LESS THAN 2 MONTHS OF AGE

2 个月以下发热婴儿的评估

• 批准号: 2235733
• 负责人: ROBERT H PANTELL
• 金额: $ 54.36万
• 依托单位: AMERICAN ACADEMY OF PEDIATRICS
• 依托单位国家: 美国
• 财政年份: 1993
• 资助国家: 美国
• 起止时间: 1993-05-01 至 1997-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2235733
• 关键词: blood chemistry; body temperature; diagnosis design /evaluation; diagnosis quality /standard; disease /disorder proneness /risk; health care professional practice; health economics; human morbidity; human subject; infant human (0-1 year); infection; mathematical model; model design /development; patient care management; prognosis; statistics /biometry; urinalysis

Fever in young infants is a problem commonly encountered by primary care physicians. Because of their developmental immaturity, young infants may not demonstrate clinical signs or behaviors which indicate underlying serious disease. This has led physicians to adopt a wide range of clinical strategies in treating these infants. Currently recommended policies for managing febrile infants vary from extensive diagnostic evaluation, hospitalization and treatment of all infants to the use of clinical judgement to selectively hospitalize and treat those infants who are at risk for serious illness. The purpose of this study is to assess what factors in the management of febrile infants are associated with variations in clinical outcomes. The questions to be addressed include: 1. What is the nature of diagnostic and treatment variability of febrile (> 38.0o C) infants (< 2 months) by office based pediatricians? What are the patient, provider and structural characteristics associated with different management strategies? 2. How effective are current clinical strategies in predicting which febrile infants have serious illness? 3. What are the benefits, harms (morbidity) and costs in febrile infants associated with these varying diagnostic and treatment strategies? 4. Can physicians identify febrile infants for whom the risk of disease is sufficiently low that a "treat-all" policy in unwarranted because the harms (morbidity) and costs of this policy exceeds the benefits and costs of a more selective strategy? We propose to utilize a nationwide group of more than 700 pediatricians in the Pediatric Research in Office Settings (PROS) of the American Academy of Pediatrics to monitor the outcome of a cohort of 6000 febrile infants less than 2 months of age cared for by PROS members. All participating physicians will gather clinical, laboratory, diagnostic and management information on febrile infants in a manner consistent with their usual practice for a two year study period. A follow-up diagnostic assessment will be done at 72-96 hours and if necessary again at 10 days to document the emergence of SBI. Analyses will be conducted to document variation in clinical care, the relative effectiveness of differing clinical strategies in preventing delay in the treatment of SBI, and the effectiveness of current clinical strategies in predicting which infants have serious illness. Recursive partitioning techniques will be used to develop a model for the prediction of the presence or absence of SBI. Different clinical strategies will be compared with respect to their relative benefits and harms. Power analyses have revealed that the sample size is adequate to answer the major questions.

幼儿发烧是初级保健中经常遇到的问题。 医生。由于发育不成熟，小婴儿可能 没有表现出临床症状或行为表明潜在的 严重的疾病。这导致医生们采用了广泛的 治疗这些婴儿的临床策略。当前推荐的 管理发烧婴儿的政策从广泛的诊断到 对所有婴幼儿进行评估、住院和治疗，以便使用 选择性入院治疗婴幼儿的临床判断 都有患重病的危险。 这项研究的目的是评估在管理中的哪些因素 发热的婴儿与临床结果的不同有关。这个 要解决的问题包括：1.诊断的性质是什么 和治疗变异性的发烧(&gt；38.0oC)婴儿(&lt；2个月)通过 办公室里的儿科医生？什么是患者、提供者和 与不同管理相关联的结构特征 策略？2.当前的临床策略在 预测哪些发烧的婴儿有严重的疾病？3.有什么 与以下因素相关的发热婴儿的益处、危害(发病率)和成本 这些不同的诊断和治疗策略？4.医生可以 确定疾病风险足够低的发烧婴儿 “一刀切”的政策是没有根据的，因为危害(发病率) 而且这项政策的成本超过了更多 有选择性的战略？ 我们建议利用一个由700多名儿科医生组成的全国性小组 在美国办公室环境下的儿科研究(PROS)中 儿科学会监测6000名发烧患者的结果 2个月以下的婴儿由专业人员照看。全 参与的医生将汇集临床、实验室、诊断和 关于发烧婴儿的管理信息的方式与 他们通常的做法是两年的学习期。后续诊断 评估将在72-96小时进行，如有必要，10天后再次进行评估 记录印度国家履行机构的出现。将进行分析以记录 在临床护理中的差异，相对有效性不同 预防SBI延迟治疗的临床策略，以及 当前临床策略在预测哪些婴儿中的有效性 得了重病。递归分区技术将用于 开发一个预测是否存在履行机构的模型。 不同的临床策略将根据他们的 相对的利与弊。电力分析显示， 样本量足以回答主要问题。