Incorporating patient preferences into practice guidelines: Management of children with fever without source

Oppenheim, Peter I.; Sotiropoulos, Georgia; Baraff, Larry J.

doi:10.1016/s0196-0644(94)70201-2

Cited by 30 publications

(16 citation statements)

References 13 publications

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“…10,11 Parents are encouraged to enter into the decision processes involved in managing ill children. 12 However, investigators less frequently assess parental preferences and do not extend this to understanding if parents desire to be offered such choices. A notable exception is Yamomoto and colleagues 13 who found that 98% of parents preferred to be included in medical decisionmaking for their children in the choice of anaesthesia or sedation for repair of lacerations.…”

Section: N B R I E Fmentioning

confidence: 99%

Parental attitudes to the care of the carious primary dentition

et al. 2003

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Section: N B R I E Fmentioning

confidence: 99%

Parental attitudes to the care of the carious primary dentition

et al. 2003

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“…This retrospective analysis allowed recognition of possible areas to pursue for efficient use of clinical laboratory services for diagnosis, consistent with current practice guidelines. 9,10 …”

Section: Procop Et Al 115mentioning

confidence: 99%

“…[9][10][11] Use and overuse of neutrophil count, neutrophil percent, and band cell percent. Temperature was evaluated as an independent variable.…”

mentioning

confidence: 99%

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

1997

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The rising costs of health care and the movement for health care reform have focused attention on methods of cost containment. Of routine laboratory and radiologic procedures, complete blood cell count (CBC) and determination of serum electrolyte values rank as high as 2nd and 9th in overall cost. We retrospectively studied use of the clinical laboratory to aid diagnosis of an acute infectious event in a pediatric emergency department population.For 5 months, we reviewed medical records of pediatric patients younger than 15 years brought to the emergency department because of a febrile episode. Of 155 cases reviewed, electrolyte concentrations were determined in 108 patients and CBC in 155. In all patients, either culture or rapid test for streptococcal organisms was performed. In addition, 838 pediatric patients with similar symptoms but who did not undergo laboratory testing were monitored for 100 days. Measures of effectiveness including sensitivity, specificity, positive and negative predictive values, and likelihood ratio were used to correlate specific laboratory findings with antibiotic therapy, serious bacterial disease, and culture positivity.Electrolyte abnormalities were found largely to be dismissed clinically, with the major clinical response consisting of parental education about hydration. The CBC profile was evaluated, with white blood cell count (WBC) indicator limits of >10,000, >10,000 but <15,000, and >15,000/mm 3 , and differentiated into absoluteThe rising costs of health care and calls for health care reform have focused attention on methods of cost containment. 1-8 Standards of care have been promulgated for specific clinical situations, in the hope of eliminating unnecessary laboratory testing and decreasing the use of tests with low yield, without compromise of patient care.9-11 Use and overuse of

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“…The physician later undertook a briefliterature search, which showed that the risk of bacterial meningitis and serious bacterial infection are about 0.5 percent (1 in 200) and 1.5 percent, respectively.3.4 A practice guideline, based upon meta-analysis, has been formulated for the management of infants with fever without source. This guideline provides solid evidence supporting close ambulatory follow-up of low-risk infants (white cell count [5][6][7][8][9][10][11][12][13][14][15],000/p.L, band cell count fewer than lS00/p.L; normal urinalysis findings; fewer than 5 white cells per highpower field in stool when diarrhea is present). 4 Interestingly enough, a later study evaluated parent preferences for the care of febrile infants without apparent source.…”

Section: Introductionmentioning

confidence: 99%

“…About 80 percent of the parents chose the ambulatory option of less testing and treatment, often basing this choice on fewer painful tests and procedures, lesser chance of unnecessary antibiotics, and the assurance that reevaluation was available if their child failed to improve. 5 The purpose of this article and others to follow in this series is to explore the dimensions and clinical relevance of evidence-based medicine in everyday primary care practice. More specifically, this series will do the following: .…”

Section: Introductionmentioning

confidence: 99%

Evidence-Based Medicine in Primary Care: An Overview

Geyman

1998

The Journal of the American Board of Family Medicine

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Case 1-1A 2-month old infant was brought into a rural island clinic at 11 PM with a temperature of 104°F (rectal).The child had been in good health from birth at full term until 2 days previously, when there was onset of intermittent fever to 104°F. There was no vomiting or lethargy. Heart rate, blood pressure, and respiratory rate were within normal limits. There was no rash and the neck was supple. The parents were observant and commented intelligently about the infant's condition. The family did not have health insurance. The last ferry to the mainland had left 1 hour earlier. The weather conditions were conducive for flying, but emergency transportation to a hospital would cost about $2000.The physician doubted that the child had a lifethreatening problem but could not be absolutely sure. He knew that the regional children's hospital 100 miles away had emergency hospital admission protocols for a sepsis work-up for infants younger than 3 months. He also knew that acute viral illness was the usual cause of illness and that most of these work-ups had negative findings for more serious problems. Though his reference books were current, he could not quantitate the risks and potential harms versus benefits of reexamination in the office 8 hours later versus emergency transportation to the hospital to work up for sepsis. The conscientious parents had the child flown to the mainland for care after talking to a pediatrician there who advised hospital admission (also without any estimates of harms versus benefits). The work-up was negative, Submitted, revised, 10 November 1997 the family acquired a sizable hospital bill, and the child was doing well without treatment 2 days later.

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Incorporating patient preferences into practice guidelines: Management of children with fever without source

Cited by 30 publications

References 13 publications

Parental attitudes to the care of the carious primary dentition

Parental attitudes to the care of the carious primary dentition

Laboratory Tests in Evaluation of Acute Febrile Illness in Pediatric Emergency Room Patients

Evidence-Based Medicine in Primary Care: An Overview

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