ASSESSMENT OF FEBRILE INFANTS LESS THAN 2 MONTHS OF AGE

婴儿发烧是基层护理经常遇到的问题 医生 由于发育不成熟，幼儿可能 没有表现出表明潜在的临床体征或行为 严重的疾病。 这导致医生采用广泛的 治疗这些婴儿的临床策略。 目前推荐 管理发热婴儿的政策从广泛的诊断 评估，住院和治疗的所有婴儿使用 临床判断，选择性地住院治疗这些婴儿， 有患重病的风险 本研究的目的是评估哪些因素在管理 发热婴儿与临床结果的变化有关。 的 要解决的问题包括：1。诊断的本质是什么 发热（> 38.0o C）婴儿（< 2个月）的治疗变异性， 办公室的儿科医生 什么是患者、提供者和 不同经营方式的结构特征 战略？ 2.目前的临床策略在以下方面有多有效： 预测哪些发热婴儿有严重疾病？ 3.有哪些 发热婴儿的获益、危害（发病率）和成本 这些不同的诊断和治疗策略 4.医生能不能 确定患病风险足够低的发热婴儿 一个“治疗所有”的政策是没有根据的，因为伤害（发病率） 这一政策的成本超过了一个更大的利益和成本。 选择性战略？ 我们建议利用全国700多名儿科医生 在美国儿科研究办公室设置（PROS） 儿科学会监测6000例发热患者队列的结局 2个月以下的婴儿由PROS成员照料。 所有 参与的医生将收集临床，实验室，诊断和 对发热婴儿的管理信息， 他们通常的做法，为期两年的研究期。 后续诊断 评估将在72-96小时进行，如有必要，在10天内再次进行 来记录SBI的出现 将进行分析，以记录 临床护理的变化，不同的相对有效性 防止SBI治疗延迟的临床策略，以及 当前临床策略在预测婴儿 得了重病 递归分区技术将用于 开发一个模型来预测SBI的存在与否。 将比较不同的临床策略， 相对的好处和坏处。 功率分析显示， 样本数目足以回答主要问题。

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.