6850 How does practice differ between London hospitals in the management of febrile infants? An analysis of data from Febrile Infants Regional Evaluation (FIRE)

Objectives Febrile infants commonly present to the emergency department. Most will have self-limiting infections; however 10–20% will have a serious bacterial infection1 and diagnosis is challenging. In the UK, three national guidelines are in use (NICE NG51, NICE NG143, BSAC2), in addition to local clinical practice guidelines (CPGs). This holds true in London where 36% of trusts used CPGs.3 Thus, there is potential heterogeneity in the management of this patient group. As part of the FIRE (Febrile Infants Regional Evaluation) study we describe variation in management of febrile infants up to 3 months of age across London hospitals. Methods This retrospective, multicentre, observational study utilised 19 London hospitals within the REACH Network.4 Data was collected on infants up to 90 days of age presenting with a fever or reported fever (≥38.0°C) between 1st April 2021–31st March 2022. Pseudo-anonymised data was compiled on REDCap by local research teams. HRA ethical approval was granted (22/PR/1377) and each participating site obtained R 54.5–96.7%) and 1387/1880 (73.8%; 53.8 -96.7%) of cases respectively. Blood cultures were taken in 1178/1880 (62.7%; 37.8–87.8%), CSF sampling was performed in 776/1880 (41.3%; 21.1–70.7%) and urinalysis/MC 37.8–85.7%). NPA/throat swabs were taken in 851/1880 (45.3%; 7–82.2%) and SARS-COV-2 investigations were performed in 1162/1880 (61.8%; 26.5–91.8%). Antibiotics were started in 1123/1843 of cases (60.9%; 39.4–91.1%). 1152/1849 (62.3%; 47.3–95.1%) cases were admitted to an inpatient ward following initial presentation; a significant minority 530/1849 (28.7%; 0–46.1%) were discharged from the place of initial assessment. The remaining 9.9% of cases were either transferred to a paediatric assessment unit or equivalent, ambulated from an inpatient setting or via a hospital-at-home service, or were transferred to PICU. The median length-of-admission was 1.4 (0.46–2.6) days. Variation in practice was seen with decreasing age of infants and depending on fever being present at initial assessment (table 1). Conclusion There is significant variation between London hospitals with respect to investigation, antimicrobial use, decision to admit and duration of stay. There is a need to standardise the approach to management of this high-risk population and limit variation in care, whilst balancing this against the burden of investigation and treatment. References Waterfield, et al, on behalf of PERUKI, Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland. Archives of Disease in Childhood. 2022;107:329–334. British Society for Antimicrobial Chemotherapy. Infant et al, on behalf of the REACH collaborative. Comparing guideline recommendations for management of young febrile infants across London. Poster presented at RCPCH Conference 2023. Available from www.reachnetworkldn.com REACH Network. Available from www.reachneworkldn.com/fire.