The epidemiology of serious bacterial infections (SBI) in children has changed since the introduction of the pneumococcal conjugate vaccine (PCV-7) in 2000. Whether Emergency Department (ED) physicians have changed diagnostic approaches to fever without source (FWS) in response is unknown. We examine trends in rates of complete blood counts (CBC), urinalyses (UA), and blood cultures among 2–24 month old children with FWS since the introduction of PCV-7.
The National Hospital Ambulatory Medical Care Survey-ED, 2001–2009 was used to identify visits to the ED by 2–24 month old children with FWS. Rates of CBC, UA, neither CBC nor UA, and blood culture were tracked across time. Trends were identified using Joinpoint regression, bivariate, and multivariate logistic regressions with year as the independent variable and ordering of each test as dependent variables.
In bivariate and multivariate analysis, CBC orders declined between 2004 and 2009 for visits by all children 2–24 months, children 2–11 months, and boys 2–24 months (adjusted OR (aOR): 0.88 per year, p<0.01; aOR: 0.88, p<0.05; and aOR: 0.83, p<0.01, respectively). Between 2004 and 2009 ordering neither CBC nor UA increased among all children 2–24 months (aOR: 1.10, p<0.05) and among boys (aOR=1.16, p<0.05). Orders for blood cultures declined across the time period in bivariate, but not multivariate analysis.
The rate of ordering a CBC for children in the 2–24 month age group presenting to the ED with FWS declined, a change coincident with the changing epidemiology of SBI since the PCV-7 vaccine was introduced.