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Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey

2020; Thieme Medical Publishers (Germany); Volume: 39; Issue: 10 Linguagem: Inglês

10.1055/s-0040-1721691

1098-8785

Lígia Maria Suppo de Souza Rugolo, Maria Regina Bentlin, Maria Fernanda Branco de Almeida, Ruth Guinsburg, Werther Brunow de Carvalho, Sérgio Tadeu Martins Marba, João Henrique Carvalho Leme de Almeida, Jorge Hecker Luz, Renato S. Procianoy, José Luiz Muniz Bandeira Duarte, Lêni Márcia Anchieta, Daniela Marques de Lima Mota Ferreira, José Mariano Sales Alves Júnior, Edna Maria de Albuquerque Diniz, Juliana Paula Ferraz dos Santos, Carolina Boschi Gimenes, Nathalia Moura de Mello e Silva, Lígia Lopes Ferrari, Regina Paula Guimarães Vieira Cavalcante da Silva, Jucille Meneses, Walusa Assad Gonçalves‐Ferri, Marynéa Silva do Vale, Holly Brine, Gary M. Weiner,

Global Maternal and Child Health

Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions.Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients.In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions.Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS.· Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..