PROS Pearls:

* Practitioners followed current guidelines in 42% of episodes. They hospitalized 309 fewer infants younger than 1 month of age and conducted fewer diagnostic tests than they would have had they followed current guidelines. Neither current guidelines nor the model developed in this study performed with greater accuracy than observed practitioner management.

* Of the 3066 infants seen during a recent national pediatric study, 1975 (64%) were managed exclusively outside the hospital. A single visit was recorded for 909 infants, while 761 infants had 2 or more visits and 305 had 3 or more visits to the hospital. The low frequency of hospitalization may be attributable to multiple office visits and/or telephone contacts.

* Bacteremia was detected in 1.8% of infants (2.4% of those tested) and bacterial meningitis in 0.5%. Despite lack of adherence to guidelines, PROS clinicians detected as many cases of bacteremia/bacterial meningitis while performing fewer tests and hospitalizing fewer infants than would have occurred if strictly adhering to practice parameters.

* The findings suggest that if close follow-up care is attainable, the management of selected cases by experienced clinicians using clinical judgment may be an appropriate alternative to strict adherence to published recommendations, with the potential benefit of reducing considerable costs and iatrogenic morbidity.