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Impact of the Step-by-Step on febrile infants
  1. Borja Gomez1,2,
  2. Amaia Fernandez-Uria1,
  3. Javier Benito1,2,
  4. Ainara Lejarzegi1,
  5. Santiago Mintegi1,2
  1. 1Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
  2. 2Department of Pediatrics, University of the Basque Country, Bilbao, País Vasco, Spain
  1. Correspondence to Dr Borja Gomez, Pediatric Emergency Department, Cruces University Hospital, Barakaldo 48903, País Vasco, Spain; borja.gomezcortes{at}osakidetza.eus

Abstract

Objective To evaluate the impact of introducing the Step-by-Step approach on care quality in young febrile infants.

Design Observational study including infants ≤90 days old with fever without source seen in a paediatric emergency department 5 years before (n=1222) and after (n=1151) its introduction. Quality of care was evaluated in terms of adherence to recommendations, resource use and safety.

Results Adherence: percentages of infants undergoing both urine and blood tests and infants <15 days old receiving full sepsis evaluation increased (84.7% vs 91.0% and 23.9% vs 63.3%, respectively; p<0.01). Resource use: lumbar puncture and admission rates decreased (24.1% vs 18.7% and 43.6% vs 38.3%, respectively; p<0.01), while the rate of antibiotic therapy increased (30.2% vs 43.2%; p<0.01). Safety: the invasive bacterial infection rate among infants managed as outpatients was unchanged (0.7% vs 0.3%; p=0.24).

Conclusion The introduction of the Step-by-Step increased the quality of care provided to young febrile infants.

  • emergency care
  • paediatric emergency medicine
  • paediatrics

Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. This study used deidentified participant data from a prospective registry developed at the paediatric emergency department of Cruces University Hospital. For additional data to be made available to a third party, specific ethical and HRA approvals would be required.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplemental information. This study used deidentified participant data from a prospective registry developed at the paediatric emergency department of Cruces University Hospital. For additional data to be made available to a third party, specific ethical and HRA approvals would be required.

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Footnotes

  • Contributors BG conceptualised and designed the study, coordinated and supervised data collection, analysed the data and wrote the initial draft of the manuscript. AF-U collected data, collaborated in the data analysis and reviewed the manuscript. AL collected data and reviewed the manuscript. JB reviewed the manuscript. SM designed the data collection instruments, collaborated in the data analysis and reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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