ArticleThe American journal of emergency medicine2026
Associations of system noise with lumbar puncture and hospitalization for young febrile infants: a cross-sectional study.
Article in The American journal of emergency medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionClinical decisions vary widely for young, febrile infants at risk for invasive bacterial infections. System noise characteristics (i.e., extraneous factors that influence clinical decisions) represents under-studied factors that may systematically affect clinical decisions for febrile infants.
objectiveTo investigate associations between system noise characteristics and clinical decisions for febrile infants.
methodsWe used New York State's all-payer database to identify febrile infants aged 8-90 days brought to emergency departments between 2016 and 2023. Clinical decision outcomes were lumbar puncture and hospitalization. We used multivariable regression to estimate adjusted odds for each clinical decision outcome in the overall cohort and for infants aged 8-28 days, 29-60 days, and 61-90 days. System noise exposures were encounter times relative to day-of-week (i.e., weekday vs. weekend), time-of-day, and changes-of-shift.
resultsOf 53,625 eligible infants, 9015 (16.8%) received lumbar puncture and 17,104 (31.9%) were hospitalized. For the overall cohort, we observed greater adjusted odds of lumbar puncture on weekdays (adjusted Odds Ratio (aOR) =1.07, 95% CI [1.02,1.13]), during the day (aOR =1.1, 95% CI [1.04,1.16]), and during change-of-shift (aOR =1.06, 95% CI [1.01,1.12]). We also observed greater adjusted odds of hospitalization on weekdays (aOR = 1.09, 95% CI [1.05, 1.14]) during the day (aOR = 1.06, 95% CI [1.01, 1.11]), and during change-of-shift (aOR = 1.34, 95% CI [1.28, 1.40]).
conclusionsSystem noise factors are significantly associated with clinical decisions for febrile infants. Future studies should investigate mechanisms through which observed differences arise and develop interventions to mitigate effects of system noise on clinical decisions for febrile infants.
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