Managing febrile infants: impact of literature recommendations published during a physician's residency

The authors hypothesized that sepsis workup recommendations are associated with practice recommendations published during the physician's residency. The first published recommendations suggesting sepsis workups for nontoxic, young, febrile infants appeared in pediatric journals from 1975-1980 and in family practice journals from 1981-1987. Data are from the Community Tracking Study (3,272 pediatricians and 2,432 family physicians). "Percentage of sepsis workups recommended" was defined by response to a vignette about the percentage of well-appearing 6-week-old children with a fever of 101 degrees F for whom the physician would recommend a sepsis workup. Multivariable regression with piecewise linear functions evaluated workup recommendations by timing of literature recommendations during residency. Pediatricians recommended sepsis workups 81.6% of the time and family physicians 67.7% (p < .001). Increased recommendations occurred among pediatricians who completed residency from 1975-1980 (p < .05) and among family physicians who completed residency from 1981-1987 (p < .005), when specialty-specific journals published recommendations for sepsis workups for febrile infants. The association between publication of sepsis workup recommendations during a physician's residency and increased sepsis workup recommendations suggests an unrecognized and enduring impact of such publications.