Impact of Integrating a Neonatal Early-Onset Sepsis Risk Calculator into the Electronic Health Record

Abstract

Introduction: Investigators from Kaiser Permanente developed a risk-assessment calculator as a tool for evaluation of early-onset sepsis (EOS) to narrow antibiotic use for the treatment of EOS. The integration of the EOS risk calculator into an electronic health record will minimize manual calculations and data entry and improve compliance and accuracy through automation. Methods: We performed a retrospective chart review for neonates ≥34 weeks and 0 days gestational age. We collected data pre-integration and post-integration of the EOS risk calculator. The primary outcome measure is the accuracy of user input into the calculator. Secondary outcomes include compliance with using the EOS risk calculator, impact on clinical recommendation when incorrectly calculated, assessment of antibiotic utilization rate (AUR), and comparison of EOS risk calculator recommendations with Centers for Disease Control and American Academy of Pediatrics recommendations. Results: Miscalculations occurred in 52% of instances pre-integration and 19% of instances post-integration; P < 0.001. Compliance was 93% pre-integration and 98% post-integration; P = 0.138. Clinical recommendations were changed for 21% (13/62) of miscalculations pre-integration and 4% (1/23) of miscalculations post-integration; P = 0.099. The AUR for combined NICU and nursery patients was 47 pre-integration and 47 post-integration; P > 0.999. Six cases of culture-positive sepsis were identified, and all recommendations generated by the EOS risk calculator were in alignment with current Centers for Disease Control/American Academy of Pediatrics treatment guidelines. Conclusions: Integration of the EOS risk calculator into the electronic health record significantly increased calculator accuracy, although it did not show statistically significant differences with regards to compliance, clinical recommendations, or AUR.

Computerized Clinical Decision Support Systems for the Early Detection of Sepsis Among Pediatric, Neonatal, and Maternal Inpatients: Scoping Review

“…All neonatal studies used quantitative methods to investigate the CCDS systems. A total of 89% (16/18) of studies were single site, with the remaining 11% (2/18) of studies involving 4 [ 66 ] and 2 sites [ 69 ]. The gestational age range of neonates included in these studies was quite diverse, with 35 weeks and older being the most common inclusion threshold ( Table 4 ).…”

“…The most common outcome used to investigate neonatal CCDS systems was sepsis treatment and management outcomes, followed by patient outcomes ( Figure 3 ; Table 4 ). CCDS-related usability and cost outcomes were only investigated by 1 and 2 studies, respectively [ 53 , 56 , 66 ] ( Figure 3 ; Table 4 ). Of the sepsis treatment and management outcomes, antibiotics-related outcomes were reported most frequently (15/18, 83%; Table 4 ).…”

Diagnostic Accuracy of the Neonatal Early Onset Sepsis Calculator in Screening for Early Onset Sepsis in Neonates More Than 35 Weeks Age of Gestation

“…12 Previous studies investigated the performance of the NEOSC which mostly involved welldeveloped and high-income countries where GBS screening of mothers is a standard. 4,12 With the GBS status of mothers being a major variable in the NEOSC, this study investigated if it will perform similarly when data about GBS status is not available. In our study it demonstrated poor sensitivity (Sn 26.12%) in detecting EOS.…”

“…These recommend empiric antibiotic initiation for all neonates who appear to be clinically ill at birth or are born to women diagnosed with chorioamnionitis. 4 Empiric treatment of newborns at risk or with suspected EOS represents the main contributor to the use of antibiotics in early life. Unnecessary evaluations and antibiotic treatment are, however, not risk-free.…”

Early-onset sepsis risk calculator: a review of its effectiveness and comparative study with our evidence-based local guidelines

“…The length of the NICU stay decreased from an average of 138 to 12 days with no negative consequences Eason et al, 2019 [ 39 ] ≥ 37 weeks’ GA infants with risk factors for EOS or suspected EOS The percentage of infants screened with a suspected infection receiving 5 days of antibiotics reduced from 31.0% with NICE guidelines to 5.0% with EOS calculator. Clinically well infants with risk factors alone receiving 36 h of antibiotics, reduced from 63.0% with NICE guidelines to 3.0% with EOS calculator Fowler et al, 2019 [ 40 ] ≥ 34 weeks’ GA 6 patients with culture-positive EOS were identified in the study period and recommendations from the calculator were in alignment with current CDC/AAP guidelines Goel et al, 2019 [ 41 ] ≥ 34 weeks’ GA 16% of infants were started on antibiotics as per NICE recommendations compared with 4.3% with EOS calculator. There were seven positive blood cultures (three infants were recommended antibiotics by both, three were not identified in the asymptomatic stage by either; one was a contaminant) Gong et al, 2019 [ 42 ] ≥ 34 weeks’ GA infants exposed to maternal intrapartum fever Compared to the CDC/AAP guidelines, the EOS calculator-based approach yields a net monetary benefit (3998 $ per infant), largely by preventing unnecessary antibiotic treatment (67.4% decrease in antibiotic use in the calculator arm) Hershkovich-Shporen et al, 2019 [ 43 ] ≥ 35 weeks’ GA newborns with the following inclusion criteria: treated with antibiotic, born to mothers with risk factors for EOS, born to mothers with clinical CAM or that received IAP 15.0% of the patients received antibiotic treatment according to 2010 CDC recommendations; 8.0% of the patients would have received antibiotic treatment according to EOS calculator.…”