The American journal of emergency medicine · 2026
Associations of system noise with lumbar puncture and hospitalization for young febrile infants: a cross-sectional study.
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Pendyala Shriya, Karki Pratikshya, Yaeger Jeffrey P
Аннотация
INTRODUCTION: Clinical 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.
OBJECTIVE: To investigate associations between system noise characteristics and clinical decisions for febrile infants.
METHODS: We 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.
RESULTS: Of 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]).
CONCLUSIONS: System 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.
OBJECTIVE: To investigate associations between system noise characteristics and clinical decisions for febrile infants.
METHODS: We 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.
RESULTS: Of 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]).
CONCLUSIONS: System 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.