A Survey of Physicians’ Opinion and Treatment Preferences Regarding Febrile Seizures in Children

Background: Fever of either low or high-grade is a big concern when present in the pediatric age group; it is much more worrisome if children are younger than 5 years of age. Fever can subside on its own or with the help of simple remedies and or medications. However, some children will develop seizures when they have a fever. Febrile seizures are one of the most common presenting complaints seen in pediatric patients in emergency room visits and physician consult. Two different types of seizures are seen in children, simple and complex seizures. Simple febrile seizures are non harming and self-limiting, while, complex seizures are prone to have long-term side effects on children. Febrile seizures can occur with or without a source of an underlying cause. In this study, we aimed to identify physicians’ opinions, knowledge, and suggestions to improve guidelines on current treatment trends for fever and fever’s association with febrile seizures in children less than 5 years of age. Objectives: To determine physicians’ opinion knowledge, and suggestions to improve guidelines on current treatment trends for fever and fever’s association with febrile seizures in children less than 5 years of age. Methods: A cross-sectional study plan was designed and conducted in June - July 2021 involving general physicians and pediatricians (n = 600). The questionnaire form including 15 closed-end questions was distributed to physicians. Descriptive statistics were used to analyse the data. Results: 100% of physicians prescribed antipyretics to control fever and or to prevent complications, especially febrile seizures. All participants were aware that axillary temperature of > 37.2 ° C is defined as fever. All most all, general physicians and most pediatricians used antipyretics to treat other associated symptoms and signs, even when the fever was absent. 76.3% believed that high fever might be an indicator of underlying serious occult bacterial infection. Almost all physicians (91.3%) advised parents to switch to the use of alternate medication when the fevers did not subside after initial treatment with paracetamol; everyone recommended that non-medical supportive treatments like tepid sponging along with antipyretics and ibuprofen to reduce the fever soonest possible. 68% of pediatricians and 90% of general practitioners believe that febrile seizures will cause brain damage. 74% of general practitioners preferred to refer children immediately to specialty centers, for further management of seizures. However, Pediatricians at tertiary care centers, as well as those in private practice used diazepam or lorazepam. Conclusion: Differences are negligible between general physicians and pediatricians while managing fever and fever complications including febrile seizures. Irrespective of the knowledge, awareness and the availability of fever guidelines by many national and international organizations, physicians are leaning towards child and parents comfort in treatment fever. The gap is wider in general physicians’ preparedness than pediatricians. A considerable gap exists to improve physicians' approach, diagnosis, and management of fever in the pediatric population.

Construction of a Retrospective Cohort to Observe 10-Year Urologic Cancer Treatment Trends at the Biggest Medical Center of South Korea

Purpose: To construct a urologic cancer database using a standardized, reproducible method, and to assess preliminary characteristics of this cohort.Materials and Methods: Patients with prostate, bladder, and kidney cancers who were enrolled with diagnostic codes in the electronic medical record (EMR) at Asan Medical Center from 2007–2016 were included. Research Electronic Data Capture (REDCap) was used to design the Asan Medical Center-Urologic Cancer Database (AMC-UCD). The process included developing a data dictionary, applying branching logic, mapping clinical data warehouse structures, alpha testing, clinical record summary testing, creating “standards of procedure,” importing data, and entering data. Descriptive statistics were used to identify rates of surgeries and numbers of patients.Results: Clinical variables (n=407) were selected to develop a data dictionary from REDCap. In total, 20,198 urologic cancer patients visited our institution from 2007–2016 (bladder cancer, 4,616; kidney cancer, 5,750; prostate cancer, 10,330). The overall numbers of patients and surgeries increased over time, with robotic surgeries rapidly growing over a decade. The most common treatment for urologic cancer was surgery, followed by chemotherapy and radiation therapy.Conclusions: Using a standardized method, the AMC-UCD fosters multidisciplinary research. This constructed database provides access to clinical statistics to effectively assist research. Preliminary data should be refined through EMR chart review. The successful organization of data from 2007–2016 provides a framework for future periods of investigation and prospective models.

757. Evaluating Use of the New ICD-10 Codes for Clostridioides difficile Infection in the Premier U.S. Hospital Discharge Database

Background The single ICD-10 code for Clostridioides difficile infection (CDI) A04.7 was replaced in Oct 2017 with two codes delineating “recurrent CDI” (rCDI, A04.71) and “nonrecurrent CDI” (nrCDI, A04.72). This study aims to evaluate and validate use of the new ICD-10 codes for CDI among inpatient encounters at hospitals contributing to the Premier Healthcare Database (PHD). Methods This retrospective study included inpatient encounters with a CDI-related ICD code between Oct 2016-May 2019 in the PHD. Trends in CDI-related ICD coding were examined pre- and post- the Oct 2017 code update. Post Oct 2017, CDI-related inpatient encounters were characterized by clinical, facility, and provider variables, and whether coding was concordant or discordant to the 2017 IDSA guidelines ‘within 60-days (2 months) from index CDI episode’ time window for capturing rCDI. Multivariable regression examined variables associated with concordant coding. Results There was widespread adoption of the new CDI codes across hospitals in the PHD in Oct 2017. Post-Oct 2017, a total of 21,446 CDI-related encounters met sample selection criteria. About 67% of rCDI encounters and 25% of nrCDI encounters were coded concordantly. In the overall sample, the rCDI vs. nrCDI-coded encounters (p< 0.05) had higher proportions with emergency room admission, admitted by a gastroenterologist or infectious disease specialist, and receiving fidaxomicin, bezlotoxumab or FMT. Trends in inpatient characteristics for rCDI vs. nrCDI-coded encounters did not differ by coding concordance status. In regression analyses, encounters coded concordantly were significantly more likely to be for rCDI (OR 5.67), a non-elective admission (OR 1.17-1.42), or prescribed fidaxomicin (OR 1.11), or FMT (OR 1.29). Encounter Frequency Frequency Table Resource and Cost Table Conclusion There was no delay in transition to the new CDI-related ICD codes across hospitals in the PHD. Important for disease management, drug treatment trends for encounters coded as rCDI vs. nrCDI were consistent with guideline-recommendations for CDI. Coding concordance status based on the IDSA 60-day time window for identifying rCDI did not affect direction of observed trends in descriptive analyses, suggesting that other validation methods maybe needed. Regression Table Disclosures Abhishek Deshpande, MD, PhD, Merck & Co., Inc (Consultant, Shareholder)The Clorox Company (Grant/Research Support) Yiyun Chen, PhD, Merck & Co., Inc (Employee) Eugenia Boye-Codjoe, MPH, Merck & Co., Inc (Employee) Engels N. Obi, PhD, Merck & Co. (Employee, Shareholder)