- Email: [email protected]
337: Significant Bacterial Infections in Febrile Children Less Than 2 Years of Age With Influenza A
Research Forum Abstracts Methods: Prospective evaluations of all infants ⬍ 90 days-old from 10/98 to 12/07 who had a sepsis evaluation for fever and an RSV antigen test performed were eligible. Data was analyzed using Statistica 6.0 with continuous variables expressed as means and categorical variables as percentages of occurrence. Results: There were 180 infants, 70 (38.8%) were RSV (⫹) and 110 (61.1%) infants were RSV (-). Median age in the RSV (⫹) group was 44.3 ⫹ 19.4 days old, and RSV (-) 43.6 ⫹ 19.2 days old. In the RSV (⫹) group there were 42 (60%) males, 15 (21.4%) Caucasians, 41 (58.5%) African Americans, and 14 (20%) Hispanics. In the RSV (-) group there were 59 (53.6%) males, 17 (15.4%) Caucasians, 77 (70.0%) African Americans, 16 (14.5%) Hispanics. In the RSV (⫹) median temperature was 38.6 ⫹ 0.6°C, while RSV (-) 38.5 ⫹ 0.5°C. In the RSV (⫹) mean HR were 170.7 ⫹ 18.5/minute with a HR ⬎ 160/minute in 37 (52.8%). In the RSV (-) mean HR was 165.9 ⫹ 21.1/minute with a HR ⬎ 160/ minute in 52 (47.2%). In the RSV (⫹) mean RR were 48.2 ⫹ 18/minute with a RR ⬎ 60/minute in 14 (20.0%). In the RSV (-) mean RR was 44.2 ⫹ 15.9/minute with a RR ⬎ 60/minute in 11 (10.0%) infants. There was no significant difference in vital signs between groups. There were more URI symptoms and coughing in the RSV (⫹) group (p ⬍ 0.05). The number admitted in RSV (⫹) group was 53 (75.7%) versus 89 (80.9%) in RSV (-). There were 8 (11.4%) infants admitted to the PICU in the RSV (⫹) group versus 2 (1.8%) in the RSV (-). The laboratory evaluation in the RSV (⫹) included a CBC 65 (92.8%), urinalysis and culture 62 (88.5%), blood culture 63 (90.0%), chest radiograph 30 (42.8%) and cerebrospinal fluid analysis 31 (44.2%). In the RSV (-) the laboratory evaluation included a CBC 100 (90.9%), urinalysis and urine culture 100 (90.9%), blood culture 102 (92.7%), chest radiograph 50 (45.4%) and cerebrospinal fluid analysis 74 (67.2%). There were more chest radiographs performed in the RSV (⫹) group (p ⬍ 0.05), while all other tests were similar. There were 10 (14.2%) significant infections in the RSV (⫹) group versus 12 (10.9%) in the RSV (-) group. In the RSV (⫹) group there were 7 (10%) pneumonias, 3 (4.2%) urinary tract infection. There were no significant (⫹) blood cultures in the RSV (⫹) group, but there were 6 (8.5%) contaminants. In the RSV (-) group there were 6 (5.4%) pneumonias, 4 (3.6%) urinary tract infection, 1 (0.9%) bacteremia with group B streptococcus, and 1 (0.9%) meningitis with enterococcus. Conclusion: The risk of serious bacterial infection is low in both RSV (⫹) group, especially if one excludes pneumonias. The prevalence of urinary tract infection is significant. Therefore, it may be prudent to exclude a urinary tract infection in febrile infants with or without (⫹) RSV antigen test.
337
Significant Bacterial Infections in Febrile Children Less Than 2 Years of Age With Influenza A
Mun ˜iz AE/The University of Texas Health Science Center at Houston, Houston, TX
Study Objectives: The prevalence of coexisting significant bacterial infections in young infants and children who have Influenza A is unknown in the era after the introduction of H. influenzae and S. pneumoniae vaccinations. The evaluation of these infants is still controversial. We hypothesize that infants with fever due to Influenza A are at low risk for secondary bacterial infection and may not require extensive and invasive laboratory evaluations. Infants were excluded if there was an obvious source for fever (excluding otitis media) and those with previous antibiotic use. Methods: Prospective evaluations of all infants ⬍ 2 years-old who presented with fever during 7 consecutive Influenzae A seasons who had a laboratory evaluation for their fever and an Influenza A antigen test performed were eligible. Data was analyzed using Statistica 6.0 with continuous variables expressed as means and categorical variables as percentages of occurrence. Results: There were 330 children, 84 (25.4%) were Influenza A (⫹) and 246 (74.5%) were Influenza A (-). Median age in the Influenza A (⫹) group was 9.9 ⫹ 8.4 months old and Influenza A (-) 10.3 ⫹ 8.4 months old. In the Influenza A (⫹) group there were 43 (51.1%) males, 8 (9.5%) Caucasians, 57 (67.8%) African Americans, and 18 (21.4%) Hispanics. In the Influenza A (-) group there were 148 (60.1%) males, 37 (15.0%) Caucasians, 170 (69.1%) African Americans, 38 (15.4%) Hispanics, and 1 Middle eastern. In the Influenza A (⫹) group median temperature was 39.5 ⫹ 0.8°C which was significantly greater than the Influenza A (-) 38.9 ⫹ 0.7°C (p ⬍ 0.05). There was no significant difference in the other vital signs between groups. There were more upper respiratory infection symptoms and coughing in the respiratory syncytial virus (⫹) group (p ⬍ 0.05). In the Influenza A (⫹) group there were 22 (26.1%) with (⫹) respiratory syncytial virus antigen, while in the Influenza A (-) there were 95 (38.1%) with (⫹) respiratory syncytial virus. Admissions occurred
S106 Annals of Emergency Medicine
more commonly in the Influenza A (-) group 127 (51.6%) versus in the Influenza A (⫹) 21 (25.0%) (p ⬍ 0.05). There were 14 (16.6%) significant infections in the Influenza A (⫹) group versus 52 (21.1%) in the Influenza A (-) group. In the Influenza A (⫹) group there were 10 (11.9%) pneumonias, 4 (34.7%) urinary tract infections, and 1 (1.1%) meningitis (Enterococcus) in a 24-day-old. There were no significant (⫹) blood cultures in the Influenza A (⫹) group, but there were 2 (2.3%) contaminants. In the Influenza A (-) group there were 39 (15.8%) pneumonias, 9 (3.6%) urinary tract infections, and 4 (1.6%) (⫹) blood cultures (K. pneumoniae, S. marcesens, S. pneumoniae). Conclusion: The risk of serious bacterial infection is low in the Influenzae (⫹) group, especially if one excludes pneumonias. There were no cases of bacteremia. Bacterial meningitis may occur in infants ⬍ 30 days-old. Also urinary tract infections are still significant in both groups. Therefore in the presence of Influenzae A, infants less than 30 days old still require a full sepsis evaluation, while all others may only require the exclusion of a urinary tract infection.
338
Emergency Medicine versus Pediatric Emergency Medicine Physicians in the Management of Febrile Infants < 1 Month of Age
Mun ˜iz AE/The University of Texas Health Science Center at Houston, Houston, TX
Study Objectives: The purpose of the study was to determine the management practices of physicians trained in emergency medicine (EM) versus physicians trained in pediatric emergency medicine (PEM) in febrile infants less than 1 month of age and evaluate their compliance with the practice guidelines. Methods: Prospective study in a university pediatric emergency department. All consecutive infants (7/99 to 12/07) less than 1 month of age with fever (⬎ 38°C) without a definite source for the infection were included. Infants are treated by PEM physicians from 8:00 am ⫺1:00 am and by EM physicians from 1:00 am - 5:00 pm. Data was analyzed using Statistica 6.0 with continuous variables expressed as means and categorical variables as percentages of occurrence. Results: Three hundred five infants, 263 (77.3%) seen by PEM physicians, 42 (13.7%) by EM physicians. The median age in the PEM group was 19.3 ⫹ 17.7 days-old (95% CI 18.2, 20.4), and in the EM group 19.2 ⫹ 8.8 days-old (95% CI 15.9, 22.4). In the PEM group there were 134 (50.9%) males, 64 (24.3%) Caucasians, 151 (57.4%) African Americans, 42 (15.9%) Hispanics, and 6 (2.2%) Asians. In the EM group there were 23 (54.7%) males, 6 (14.2%) Caucasians, 31 (73.8%) African Americans, 3 (7.1%) Hispanics, 3 Asians (7.1%). There were no significant differences between groups in their demographic data, vital signs, or symptoms. The number admitted in the PEM group was 240 (91.2%) which was less than the EM group, 42 (100%) (p ⬍ 0.05). The laboratory evaluation in the PEM group included a CBC 246 (93.5%), urinalysis and culture 246 (93.5%), blood culture 246 (93.5%), chest radiograph 106 (40.3%) and cerebrospinal fluid analysis 240 (91.2%). In the EM all children had a CBC, urinalysis and urine culture, blood culture, cerebrospinal fluid analysis performed. There were 35 (83.3%) chest radiograph performed. There were more chest radiographs performed in the EM group (p ⬍ 0.05), while all other tests were similar. Conclusion: There are still some differences in the management of young febrile infants. EM physicians are loyal to the guidelines and order more chest radiographs than the PEM physicians. This study also showed a significant amount of significant bacterial infections in both the low- and high-risk groups. Therefore it is prudent to admit these children with a full evaluation for sepsis.
339
Characteristics of Patients Undergoing Rapid HIV Testing in a NYC Emergency Department
Egan D, Lech C/St. Luke’s Roosevelt Hospital Center, New York, NY; New York Medical College, Valhalla, NY
Study Objectives: To identify demographic and behavioral characteristics of patients undergoing rapid HIV testing in the ED. To evaluate the experiences of patients with previous HIV testing both in the ED and primary care settings. Methods: This pilot study was conducted in a NYC ED located in a section of Manhattan with a high prevalence of HIV infection. Patients undergoing rapid oral HIV testing in the ED were approached by a research assistant for participation in the study. Subjects completed a two-page survey identifying demographic information, sexual and drug use practices, and HIV testing history. Frequencies were calculated for data points.
Volume , . : September
337
Significant Bacterial Infections in Febrile Children Less Than 2 Years of Age With Influenza A
Mun ˜iz AE/The University of Texas Health Science Center at Houston, Houston, TX
Study Objectives: The prevalence of coexisting significant bacterial infections in young infants and children who have Influenza A is unknown in the era after the introduction of H. influenzae and S. pneumoniae vaccinations. The evaluation of these infants is still controversial. We hypothesize that infants with fever due to Influenza A are at low risk for secondary bacterial infection and may not require extensive and invasive laboratory evaluations. Infants were excluded if there was an obvious source for fever (excluding otitis media) and those with previous antibiotic use. Methods: Prospective evaluations of all infants ⬍ 2 years-old who presented with fever during 7 consecutive Influenzae A seasons who had a laboratory evaluation for their fever and an Influenza A antigen test performed were eligible. Data was analyzed using Statistica 6.0 with continuous variables expressed as means and categorical variables as percentages of occurrence. Results: There were 330 children, 84 (25.4%) were Influenza A (⫹) and 246 (74.5%) were Influenza A (-). Median age in the Influenza A (⫹) group was 9.9 ⫹ 8.4 months old and Influenza A (-) 10.3 ⫹ 8.4 months old. In the Influenza A (⫹) group there were 43 (51.1%) males, 8 (9.5%) Caucasians, 57 (67.8%) African Americans, and 18 (21.4%) Hispanics. In the Influenza A (-) group there were 148 (60.1%) males, 37 (15.0%) Caucasians, 170 (69.1%) African Americans, 38 (15.4%) Hispanics, and 1 Middle eastern. In the Influenza A (⫹) group median temperature was 39.5 ⫹ 0.8°C which was significantly greater than the Influenza A (-) 38.9 ⫹ 0.7°C (p ⬍ 0.05). There was no significant difference in the other vital signs between groups. There were more upper respiratory infection symptoms and coughing in the respiratory syncytial virus (⫹) group (p ⬍ 0.05). In the Influenza A (⫹) group there were 22 (26.1%) with (⫹) respiratory syncytial virus antigen, while in the Influenza A (-) there were 95 (38.1%) with (⫹) respiratory syncytial virus. Admissions occurred
S106 Annals of Emergency Medicine
more commonly in the Influenza A (-) group 127 (51.6%) versus in the Influenza A (⫹) 21 (25.0%) (p ⬍ 0.05). There were 14 (16.6%) significant infections in the Influenza A (⫹) group versus 52 (21.1%) in the Influenza A (-) group. In the Influenza A (⫹) group there were 10 (11.9%) pneumonias, 4 (34.7%) urinary tract infections, and 1 (1.1%) meningitis (Enterococcus) in a 24-day-old. There were no significant (⫹) blood cultures in the Influenza A (⫹) group, but there were 2 (2.3%) contaminants. In the Influenza A (-) group there were 39 (15.8%) pneumonias, 9 (3.6%) urinary tract infections, and 4 (1.6%) (⫹) blood cultures (K. pneumoniae, S. marcesens, S. pneumoniae). Conclusion: The risk of serious bacterial infection is low in the Influenzae (⫹) group, especially if one excludes pneumonias. There were no cases of bacteremia. Bacterial meningitis may occur in infants ⬍ 30 days-old. Also urinary tract infections are still significant in both groups. Therefore in the presence of Influenzae A, infants less than 30 days old still require a full sepsis evaluation, while all others may only require the exclusion of a urinary tract infection.
338
Emergency Medicine versus Pediatric Emergency Medicine Physicians in the Management of Febrile Infants < 1 Month of Age
Mun ˜iz AE/The University of Texas Health Science Center at Houston, Houston, TX
Study Objectives: The purpose of the study was to determine the management practices of physicians trained in emergency medicine (EM) versus physicians trained in pediatric emergency medicine (PEM) in febrile infants less than 1 month of age and evaluate their compliance with the practice guidelines. Methods: Prospective study in a university pediatric emergency department. All consecutive infants (7/99 to 12/07) less than 1 month of age with fever (⬎ 38°C) without a definite source for the infection were included. Infants are treated by PEM physicians from 8:00 am ⫺1:00 am and by EM physicians from 1:00 am - 5:00 pm. Data was analyzed using Statistica 6.0 with continuous variables expressed as means and categorical variables as percentages of occurrence. Results: Three hundred five infants, 263 (77.3%) seen by PEM physicians, 42 (13.7%) by EM physicians. The median age in the PEM group was 19.3 ⫹ 17.7 days-old (95% CI 18.2, 20.4), and in the EM group 19.2 ⫹ 8.8 days-old (95% CI 15.9, 22.4). In the PEM group there were 134 (50.9%) males, 64 (24.3%) Caucasians, 151 (57.4%) African Americans, 42 (15.9%) Hispanics, and 6 (2.2%) Asians. In the EM group there were 23 (54.7%) males, 6 (14.2%) Caucasians, 31 (73.8%) African Americans, 3 (7.1%) Hispanics, 3 Asians (7.1%). There were no significant differences between groups in their demographic data, vital signs, or symptoms. The number admitted in the PEM group was 240 (91.2%) which was less than the EM group, 42 (100%) (p ⬍ 0.05). The laboratory evaluation in the PEM group included a CBC 246 (93.5%), urinalysis and culture 246 (93.5%), blood culture 246 (93.5%), chest radiograph 106 (40.3%) and cerebrospinal fluid analysis 240 (91.2%). In the EM all children had a CBC, urinalysis and urine culture, blood culture, cerebrospinal fluid analysis performed. There were 35 (83.3%) chest radiograph performed. There were more chest radiographs performed in the EM group (p ⬍ 0.05), while all other tests were similar. Conclusion: There are still some differences in the management of young febrile infants. EM physicians are loyal to the guidelines and order more chest radiographs than the PEM physicians. This study also showed a significant amount of significant bacterial infections in both the low- and high-risk groups. Therefore it is prudent to admit these children with a full evaluation for sepsis.
339
Characteristics of Patients Undergoing Rapid HIV Testing in a NYC Emergency Department
Egan D, Lech C/St. Luke’s Roosevelt Hospital Center, New York, NY; New York Medical College, Valhalla, NY
Study Objectives: To identify demographic and behavioral characteristics of patients undergoing rapid HIV testing in the ED. To evaluate the experiences of patients with previous HIV testing both in the ED and primary care settings. Methods: This pilot study was conducted in a NYC ED located in a section of Manhattan with a high prevalence of HIV infection. Patients undergoing rapid oral HIV testing in the ED were approached by a research assistant for participation in the study. Subjects completed a two-page survey identifying demographic information, sexual and drug use practices, and HIV testing history. Frequencies were calculated for data points.
Volume , . : September