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Applying clinical decision aids for the assessment and management of febrile infants ≤90 days presenting to emergency care in the UK and Ireland: Febrile Infant Diagnostic Assessment and Outcome (FIDO) study Etimbuk Umana (12680938) PUREID: 631217890 Febrile infants clinical decision aids invasive bacterial infection cost-effectiveness diagnostic accuracy Managing febrile infants under 90 days presents unique challenges as they often lack obvious infection symptoms. These infants face increased risks of invasive bacterial infections (IBIs) and urinary tract infections (UTIs), particularly those under 28 days. While UK guidelines recommend a cautious approach involving lumbar puncture and hospitalisation, international clinical decision aids (CDAs) offer alternative sequential assessment methods to identify low-risk cases. These CDAs consider age, appearance, and biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) to evaluate IBI risk. This thesis examined febrile infant care, comparing local and international CDAs, evaluating biomarker performance, and studying risk communication between clinicians and parents. Through six work packages, the research included a scoping review of existing CDAs, meta-analysis of PCT and CRP accuracy, and a prospective study (FIDO) evaluating CDA performance and cost-effectiveness. Key findings showed that PCT (0.5ng/ml) demonstrated superior diagnostic accuracy compared to CRP (20mg/L), though this advantage diminished when incorporated into CDAs. The FIDO study revealed an IBI prevalence of 3.7%, with E.coli as the primary pathogen. Both AAP and BSAC CDAs showed high sensitivity (0.99) but lower specificity. Respiratory viral testing proved beneficial for infants over 28 days, with positive results indicating lower IBI risk. The qualitative component revealed that parents' decision-making preferences evolved from clinician-led to collaborative approaches as their child improved. CDAs proved valuable as communication tools, helping build trust between clinicians and parents. These findings contribute to improving the management of febrile infants in UK and Irish healthcare settings.<br><br><i>Thesis is embargoed until 31 December 2026.</i> 2026-10-01T16:28:06Z Text Thesis 10.17034/32640813.v1 https://figshare.com/articles/thesis/Applying_clinical_decision_aids_for_the_assessment_and_management_of_febrile_infants_90_days_presenting_to_emergency_care_in_the_UK_and_Ireland_Febrile_Infant_Diagnostic_Assessment_and_Outcome_FIDO_study/32640813 All Rights Reserved Open Access after 2026-12-31