Charges and complications associated with the medical evaluation of febrile young infants.

Background: Since 1983, no study has evaluated the costs and complications involved in the inpatient evaluation of antibiotic therapy for febrile infants aged 29 to 60 days.

Methods: A prospective quality indicator/quality assurance study of low-risk febrile young infants (FYIs) was conducted during a 16-month period after a retrospective pilot study. One investigator (C.C.) followed the medical course of enrolled FYIs, including 3 standardized scheduled phone follow-ups with the subject's parent and primary care provider (PCP) within the 2 weeks after discharge.

Results: Sixty-two subjects were enrolled during the 16-month period (58 admitted and 4 discharged subjects). Two (3%) subjects who met low-risk criteria developed a serious bacterial infection, both urinary tract infections. No cases of true bacteremia or bacterial meningitis were diagnosed. Seventeen subjects (29.3%) developed a complication during the admission. The mean length of inpatient stay was 49.0 hours (range, 18.1-65.4 hours). The mean charge for hospitalization was $6202 (range, $2818-$9880). Scheduled phone follow-up was successful on days 2 (77.4%), 7 (85.4%), and 14 (83.9%) after discharge. All patients were reported as improved (100%), and most parents preferred discharge to admission (66%-70%). In the 2 weeks after discharge, only 45 (72.6%) of 62 subjects had followed up with their PCPs.

Conclusions: This prospective quality indicator/quality assurance study demonstrates that inpatient evaluation of low-risk FYIs results in high charges and potentially preventable complications. Hospitalization is contrary to the wishes of most parents in this study; however, the rate of appropriate follow-up with a PCP in this study is concerning.