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Identifying neonatal early-onset sepsis test and treatment decision thresholds

Journal of Perinatology volume 41, pages 1278–1284 (2021)Cite this article

Subjects

Abstract

Objective

To derive testing and treatment thresholds for early-onset neonatal sepsis and compare them to thresholds used in the Kaiser-Permanente (KP) Sepsis Calculator.

Methods

Using surveys distributed in the United States, Brazil and Italy, decision thresholds were derived via self-identified thresholds selected from structured lists (Method 1), and based on clinical vignette responses for testing and treatment with or without inclusion of associated relative risk (Methods 2 and 3).

Results

Using Method 1, both testing and treatment thresholds were higher than the KP calculator thresholds. Test thresholds were lower (Method 2) or equivalent (Method 3) to KP using clinical vignettes. No vignette reached the 50% cutoff necessary to define a treatment threshold.

Conclusion

The test threshold used by the KP calculator is the same as the threshold chosen by clinicians given a vignette and risk estimate. The KP treatment threshold is lower than that derived using all 3 methods.

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Fig. 1: Distribution of self-identified blood test thresholds for early-onset neonatal sepsis.
Fig. 2: Distribution of self-identified antibiotic treatment thresholds for early-onset neonatal sepsis.
Fig. 3: Proportion of respondents choosing empiric antibiotic therapy when presented with a clinical vignette alone (Method 2).
Fig. 4: Proportion of respondents choosing empiric antibiotic therapy when presented with a clinical vignette and the risk of sepsis (Method 3).

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Author information

Authors and Affiliations

  1. Duke University Medical Center, Durham, NC, USA

    Sharla Rent

  2. Toledo Children’s Hospital, Toledo, OH, USA

    Holly Brine

  3. Brazilian Network on Neonatal Research, Sao Paulo, Brazil

    Maria Fernanda de Almeida, Ruth Guinsburg & Ligia Rugolo

  4. Fondazione IRCCS Ca’ Granda Ospedale Maggiore, Milano, Italy

    Fabio Mosca

  5. Universita degli Studi di Padova, Padova, Italy

    Daniele Trevisanuto

  6. University of Michigan, Ann Arbor, MI, USA

    Gary Weiner

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  1. Sharla Rent
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Contributions

GW conceptualized the study, aided in dissemination of the survey, participated in data analysis, reviewed and revised the manuscript. HB conceptualized the study, designed the survey, reviewed and revised the manuscript. SR analyzed the data, drafted and revised the manuscript. FM assisted with data collection and review of the manuscript. FMdA, RG, LR, and DT participated in dissemination of the survey, participated in data analysis, reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Correspondence to Sharla Rent.

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Rent, S., Brine, H., de Almeida, M.F. et al. Identifying neonatal early-onset sepsis test and treatment decision thresholds. J Perinatol 41, 1278–1284 (2021). https://doi.org/10.1038/s41372-021-00981-3

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