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<p>Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90&#xa0;days of age presenting with fever or caregiver reported fever between 1st April 2021—31st March 2022 were included. Outcome measures were variations&#xa0;in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4–96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1–70.7%), 63.4% had urinalysis (43.4–85.4%) and 62.2% were investigated for SARS-CoV2 (26.5–91.7%). Antibiotics were started in 57.7% (35.4–90.2%) and 63.5% (46.7–99.2%) were admitted. Infants aged &lt; 28&#xa0;days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8–35.4%), partial adherence in 24.4% (18.0–35.3%), non-adherence in 31.2% (10.6–47.4%), and over-adherence in 23.5% (8.0–44.7%). CPG adherence was higher in infants aged &lt; 28&#xa0;days.</p><p><i>Conclusions</i>: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.</p>

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Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study

  • 期刊论文

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  • 发表日期：

    2026年5月8日

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  • Stephanie Habermann,
  • Rose Hartzenberg,
  • Eva M. Loucaides,
  • George Lawson,
  • Dominic Carr,
  • Ian Maconochie,
  • Ruud G. Nijman,
  • Nadia Abdulla,
  • Gbemiga Adeoye,
  • Sarah Al Rawi,
  • Mohammad Alam,
  • Sandy Alatzoglou,
  • Humera Ali,
  • Andres Almario,
  • Alexia Alvarez,
  • Alexandros Argyropoulos,
  • Demetris Athanasiou,
  • Nadia Audhali,
  • Nadja Bednarczuk,
  • Shirin Beebeejaun,
  • Sarah Brown,
  • Marnie Bruce,
  • Sarah Chambers,
  • Sabina Checketts,
  • Rhea Clubb,
  • Rosie Crane,
  • Sally-Ann Delaney,
  • Ioannides Demetris,
  • Rhys Dore,
  • Michelle D’Souza,
  • Omar Elsawi,
  • Aderonke Evbuomwan,
  • Sara Farhat Dominguez,
  • Mehreen Farooqi,
  • Margherita Faulkner,
  • Elizabeth Fitchett,
  • Suchika Garg,
  • Neelakshi Ghosh,
  • Claire Girdler,
  • Nuha Gurafi,
  • Eiman Hajahmed,
  • Sarah Hallett,
  • Liza Hallinan,
  • Basma Haroun,
  • Erin Hart,
  • Noha Heikal,
  • Christine Hesketh,
  • Amy Holman,
  • Sasha Howard,
  • Demetris Ioannides,
  • Hannah Jacob,
  • Nasreen Kamarus,
  • Misbah Khan,
  • Sadaf Kiani,
  • Krizstina Kiss,
  • Neave Kissane,
  • May Ko,
  • Louiza Kontara,
  • Gregory Landon,
  • Daniel Langer,
  • Cheryl Lau,
  • Robert Legg,
  • Cheryl Lim,
  • Zhia Lim,
  • Naomi Lin,
  • Conan Lundy,
  • Ashwin Mahtani,
  • Michelle Maria,
  • Jennifer Martin,
  • Kate Mcmonnies,
  • Ramlah Mehmood,
  • Valerie Milton,
  • Basma Mohamed,
  • Abdifatah Mohamud,
  • Claire Mulvenaa,
  • Evangelia Myttarakis,
  • Georgina Nukwe,
  • Fran Neale,
  • Emine Nebati,
  • Maggie Nyirendra,
  • Elizabeth O’Mahoney,
  • Jo O’Sullivan,
  • Ashley Ong,
  • Burcu Ozen,
  • Nana Palm,
  • Konstantina Papagianni,
  • Soonie Patel,
  • Aikaterina Perogiannaki,
  • Caroline Philips,
  • Vasundhara Piyadarshani,
  • Ajith Prasad,
  • Alexia Prol Alvarez,
  • Raj Radhakirshnan,
  • Trisha Radia,
  • Yash Rajeev,
  • Saiqua Raoof,
  • Nilanjana Ray,
  • Jessica Roberts,
  • Hamish Robertson,
  • Jennifer Rossiter,
  • Niamh Scally,
  • Isabel Schulz,
  • Elinor Sefi,
  • Upeka Senanayake,
  • Chid Sethuraman,
  • Jessica Severe,
  • Mashal Shamsuddin,
  • Lucy Shimwell,
  • Khallad Shoaib,
  • Banuja Srikumar,
  • Kokul Sriskandarajah,
  • Anna Starling,
  • Claire Stewart,
  • Claire Strauss,
  • Sarah Sturrock,
  • Constantinos Televantos,
  • Radhika Thakrar,
  • Michelle Themalil,
  • Kyra Theron,
  • Rachel Thompson,
  • Hanna Tilly,
  • Rebecca Unsworth,
  • Kin Wai Man,
  • Marie White,
  • Abigail Whitehouse,
  • Emma Williams,
  • Georgina Yan,
  • Su Ywel,
  • Chris Zhang

摘要

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021—31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4–96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1–70.7%), 63.4% had urinalysis (43.4–85.4%) and 62.2% were investigated for SARS-CoV2 (26.5–91.7%). Antibiotics were started in 57.7% (35.4–90.2%) and 63.5% (46.7–99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8–35.4%), partial adherence in 24.4% (18.0–35.3%), non-adherence in 31.2% (10.6–47.4%), and over-adherence in 23.5% (8.0–44.7%). CPG adherence was higher in infants aged < 28 days.

Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.