Physician and Infant Factors Drive Variation in Febrile Infant Care

Researchers analyzed statewide administrative data for 35,756 infants aged 8–60 days who presented with fever to New York emergency departments between January 2012 and July 2021. Using multilevel logistic regression, they estimated how infant-, physician- and hospital-level factors contributed to variation in hospitalization and lumbar puncture. The study period preceded publication of the American Academy of Pediatrics’ febrile-infant guideline in 2021.

Overall, 18,124 infants (49%) were hospitalized and 12,959 (36%) received a lumbar puncture. In adjusted models, physician-level factors contributed the largest reported share of variation in hospitalization (59.3%), while infant-level factors contributed the largest share of variation in lumbar puncture decisions (81.9%). Hospital-level factors accounted for more than 10% of hospitalization variation and approximately 10% of lumbar puncture variation. Hospital-level variation did not differ significantly between infants aged 8–28 and 29–60 days.

The findings identify potentially modifiable hospital-level contributions to care variation, but do not test interventions or establish whether differences in care were appropriate. The retrospective analysis relied on administrative data from one state and reflects practice before the 2021 guideline; its results may not represent current practice or other settings.