Evidence map›Paper›PMID 37559485›Full record

ArticleThe Permanente journal2023

CA FIRST (California Febrile Infant Risk Stratification Tool) Algorithm Development in a Learning Health System.

Tara L Greenhow, Tran Hp Nguyen, Beverly R Young, Madeline J Somers, Jie Huang, Amy Alabaster, David R Vinson, Dustin G Mark, Patrick J Van Winkle, Adam L Sharp and 5 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in The Permanente journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.7field-weighted citation impact, top 14% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 3 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 1 country.

Tara L GreenhowDivision of Infectious Diseases, Department of Pediatrics, Kaiser Permanente Northern California, San Francisco, CA, USA.ORCID 0000-0002-3480-7895
Tran Hp NguyenThe Permanente Medical Group, Oakland, CA, USA.
Beverly R YoungThe Permanente Medical Group, Oakland, CA, USA.
Madeline J SomersDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Jie HuangDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Amy AlabasterDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
David R VinsonThe Permanente Medical Group, Oakland, CA, USA.
Dustin G MarkThe Permanente Medical Group, Oakland, CA, USA.
Patrick J Van WinkleDepartment of Pediatrics, Kaiser Permanente Southern California, Anaheim, CA, USA.
Adam L SharpKaiser Permanente Bernard J. Tyson School of Medicine, Health Systems Science Department, Pasadena, CA, USA.
Mary E ReedDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Judy ShanSchool of Medicine, University of California, San Francisco, CA, USA.
Jennifer Y ZhangDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Adina S RauchwergerDivision of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
Dustin W BallardThe Permanente Medical Group, Oakland, CA, USA.
Kaiser Permanente · USKaiser Permanente Roseville Medical Center · USUniversity of California, San Francisco · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction There is considerable variation in the approach to infants presenting to the emergency department (ED) with fever. The authors' primary aim was to develop a robust set of algorithms using community ED data to inform modifications of broader clinical guidance. Methods The authors report the development of California Febrile Infant Risk Stratification Tool (CA FIRST) using key components of the Roseville Protocol (ROS) and American Academy of Pediatrics (AAP) Clinical Practice Guideline (CPG). Expanded guidance was derived using a retrospective analysis of a cohort of 3527 febrile infants aged 7-90 days presenting to any Kaiser Permanente Northern California ED between 2010 and 2019 who underwent a core febrile infant evaluation. Results Melding ROS and AAP CPG algorithms in infants 7-60 days old, CA FIRST Algorithms had comparable performance characteristics to ROS and AAP CPG. CA FIRST enhancements included guidance on febrile infants 61-90 days old, high-risk infants, infants with bronchiolitis, and infants who received immunizations within the prior 48 hours. This retrospective analysis revealed that of 235 febrile infants 22-90 days old with respiratory syncytial virus and 221 who had fever in the 48 hours following vaccination, there were no cases of invasive bacterial infection. Discussion CA FIRST is a set of 13 algorithms providing a thoughtful and flexible approach to the febrile infant while minimizing unnecessary interventions. Conclusions CA FIRST Algorithms empower clinicians to manage most febrile infants. Algorithms are being modified as new data become available, imparting useful and ever-current educational information within a learning health care system.

Indexed as

Learning Health SystemAlgorithmsCaliforniaChildFeverHumansInfantReactive Oxygen SpeciesRetrospective StudiesRisk AssessmentReactive Oxygen Species

Identifiers

PMID37559485
PMCPMC10502387
OpenAlexW4385716711

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC-ND
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.