Hospital Adherence to New Guideline on Treatment of Febrile Infants Evaluated; New Disparities Emerge

A study, “Disparities in Guideline Adherence for Febrile Infants in a National Quality Improvement Project,” evaluated hospitals’ adherence by patient race and ethnicity to a Clinical Practice Guideline developed in 2021 by the American Academy of Pediatrics to improve standardized evidenced-based care. The study, published in the September 2024 Pediatrics (published online Aug. 19) included 16,961 infants in in a quality improvement collaborative of 99 U.S. hospitals across two time periods: baseline (November 2020 – October 2021) and intervention (November 2021 – October 2022). Researchers found emerging differences in the provision of guideline-concordant care for infants with fever by race and ethnicity. There were no differences seen in primary measures, which included appropriate lumbar punctures, appropriate disposition from the emergency department, appropriate receipt of antibiotics, and appropriate length of inpatient stay. During the intervention period, however, researchers found fewer Hispanic and Latino infants having inflammatory markers obtained and fewer Black and Hispanic and Latino infants having documented shared decision-making. A lower proportion of Hispanic and Latino infants received appropriate follow-up recommendations from the emergency department. The authors suggest that future guidelines intentionally integrate best practices for equity-focused quality improvement and pursue rigorous analysis of implementation results by race and ethnicity. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.