Variation in management of febrile infants younger than 90 days across London: a retrospective cohort study.

Evaluate variation in care of febrile infants presenting to London hospitals and adherence to national Clinical Practice Guidelines (CPGs). Retrospective multicentre cohort study conducted at 21 London hospitals. Infants ≤ 90 days of age presenting with fever or caregiver reported fever between 1st April 2021-31st March 2022 were included. Outcome measures were variations in patient management and adherence to national CPGs. Of 2,008 presentations, 41.1% were febrile during assessment. 73.7% had blood tests (range across hospital sites: 55.4-96.7%), 40.8% had cerebrospinal fluid (CSF) testing (17.1-70.7%), 63.4% had urinalysis (43.4-85.4%) and 62.2% were investigated for SARS-CoV2 (26.5-91.7%). Antibiotics were started in 57.7% (35.4-90.2%) and 63.5% (46.7-99.2%) were admitted. Infants aged < 28 days and infants febrile during assessment were more likely to undergo investigations and be admitted. Adherence varied significantly across sites: full adherence to CPGs was achieved in 21.9% (site range 8.8-35.4%), partial adherence in 24.4% (18.0-35.3%), non-adherence in 31.2% (10.6-47.4%), and over-adherence in 23.5% (8.0-44.7%). CPG adherence was higher in infants aged < 28 days.Conclusions: There was wide variation in care across London hospitals with limited adherence to guidelines. This highlights the need to focus on refining and updating decision models and CPGs, with more specific recommendations for managing infants who are afebrile during initial assessment. Clear guidance with a focus on reducing missed diagnosis may impact patient safety and economical expenditure.