369 - Factors and Outcomes Associated with Hospitalization and Emergency Department Discharge for Children With Fever of Unknown Origin

Poster Number: 369
Publication Number: 369.206

Purva U. Patel, Baylor College of Medicine, Houston, TX, United States; Hannah Neubauer, Baylor College of Medicine, Houston, TX, United States; Ankhi Dutta, Texas Children's Hospital, Houston, TX, United States; Sarah D. Meskill, Baylor College of Medicine, Houston, TX, United States

Background: In children with fever of unknown origin (FUO), it is often challenging to differentiate benign diagnoses from more serious etiologies. FUO can be associated with prolonged hospital stays and high costs. Literature is limited in this population, and outcomes from the emergency department (ED) setting have not yet been studied. Given the wide array of potential diagnoses for FUO, we hypothesized that there is variability in disposition decisions and perhaps the opportunity to promote high value care through reducing resource utilization.

Objective: We aimed to describe the factors associated with hospitalization in children with FUO and compare the outcomes between those hospitalized and those discharged from the ED.

Design/Methods: We conducted a single center, retrospective, cross-sectional study of previously healthy children aged 6 months to 18 years, who presented to a quaternary children’s hospital ED from 1/2017 to 12/2019 in the southern United States. Children included had an initial ICD-10 encounter diagnosis code of FUO or prolonged fever, and reported fever for >=7 days without localizing signs or symptoms of infection at presentation. Outcome measures included association factors defined a priori and adverse outcomes. Descriptive statistics and backward-step approach using binary logistic regression modeling were used to describe outcomes.

Results: Three hundred fifty one children with FUO were included, with 113 (32%) hospitalized at initial presentation (Table 1). Factors associated with hospitalization included a prior outpatient evaluation by a primary care physician (aOR 1.59; 95% CI, 1.25 – 2.03) or subspecialist (aOR 3.79; 95% CI, 1.63 – 8.81) and abnormal c-reactive protein level (aOR 6.64; 95% CI, 2.62 – 16.79). Two children hospitalized required escalation of care without ventilator or vasopressor support. Median length of stay was 2 days. Median hospitalization cost was $20,458.00 and almost half remained undiagnosed at hospital discharge (Table 2). Of the 238 children discharged from the ED, 18 (8%) returned to the ED for FUO within 30 days, of which 13 (72%) were hospitalized. Majority of children discharged from the ED remained undiagnosed (Table 2).Conclusion(s): Factors associated with hospitalization reflected either prior attempt at outpatient evaluation or lab value reflecting systemic inflammation. Most children remained undiagnosed, adverse outcomes were rare in both groups, and hospitalizations were short with high costs. Future studies can evaluate the individual provider factors that influence disposition decisions.
Table 1: Demographics and clinical factors for children with FUO
Table 2: Outcomes in Children with FUO