P0298 - Provider Characteristics Associated with Ordering Meningitis/Encephalitis Panel for Young Febrile Infants

Background: The BioFire® FilmArray Meningitis/Encephalitis Panel (MEP) provides a one-hour turnaround time for detection of 14 common viral and bacterial pathogens in cerebrospinal fluid (CSF). This test became available at our institution in July 2017.

Purpose: To investigate differences in provider characteristics in use of the new MEP test for evaluation of febrile infants 60 days and younger.

Methods: Retrospective review of the electronic medical record of pediatric emergency department (ED) encounters from July 2017 to April 2019 at a pediatric tertiary care hospital and associated community satellite. We included all encounters involving febrile infants 60 days and younger with CSF cultures. Providers were identified as the patient’s first assigned physician. Provider training categories were defined as pediatrics residency without pediatric emergency medicine (PEM) fellowship, emergency medicine (EM) residency with or without PEM fellowship, and pediatric-trained, board-certified PEM. We manually reviewed board certification years to calculate provider years of experience. Years of experience was evaluated as both a continuous and categorical variable (< 2 years since board-certification, 2-10 years, or >10 years); these categories were selected based on first and third quartiles. We evaluated bivariable associations between categorical variables and the outcome of MEP testing using logistic regression. In the multivariable analysis, our variables of interest were provider training category, trainee involvement (medical student or resident), and provider years of experience. Covariates included in the logistic regression model were patient race, term status, sex, age, and peripheral white blood cell count. We report odds ratios (OR), adjusted odds ratios (aOR), and 95% confidence intervals.

Results: There were 354 cases, of which 108 (31%) had MEP ordered. Of the 354 encounters, 155 were PEM, 182 Pediatrics, and 17 EM. There was no significant difference in MEP ordering between PEM and Pediatrics providers (OR 0.9, [95% CI 0.6-1.4]). Encounters involving EM providers were more likely to have MEP ordering than encounters involving Pediatrics providers (58.8% vs. 30.2%, OR 3.3, [95% CI 1.2-9.1]). Years of provider experience was not associated with MEP. Providers were more likely to order MEP when a trainee participated in patient care (OR 2.7, [95% CI 1.6-5.0]). In multivariable analyses, patients were more likely to have MEP ordering when seen by a trainee (aOR 2.7, [95% CI 1.5-5.0]) and when their provider was EM trained (aOR 3.1, [95% CI 1.0-9.7]) (Table 1).

Conclusion: Rates of MEP use were higher for febrile infants seen by EM-trained providers and for encounters involving trainees. Further research is needed to understand the reasons for these differences.