71: Impact of a Novel Predictive Model for Early-Onset Neonatal Sepsis Evaluation
Notice bibliographique
Résumé
The multivariate risk model proposed by Puopolo et al (Pediatrics 2011;128(5):e11655–1163) has been shown to identify 35% fewer asymptomatic infants born at ≥ 36 weeks in a single maternity center as high risk for early onset neonatal sepsis (EOS) when compared with standard algorithms. (Mukhopadhyay et al E-PAS2013:3355.6) To retrospectively examine the number of infants assessed and treated for EOS using local guidelines in a Canadian neonatal unit in comparison with the numbers that would have been assessed by using the quantitative multivariate risk model of Puopolo et al. Retrospective cohort study of infants born at ≥34 weeks gestational age (GA) admitted to a Canadian NICU, between July 2012 and June 2013. The cohort, which includes infants admitted to the NICU for a variety of clinical and child welfare reasons, was first stratified into high- and low-risk groups according to the risk calculated by the model of Puopolo et al. This model uses GA highest maternal intrapartum temperature, duration of rupture of membranes, maternal group B Strep status as well as timing and type of intrapartum antibiotics to calculate a risk. A value of ≥0.5 per 1000 live births was used to define high risk and therefore the threshold for assessment and treatment. The numbers who were investigated (CBC, blood culture, or CSF culture) and/or treated for EOS within each group were then identified. 89.5% (239 of 267) of infants were calculated as being low risk while 10.5% (28 of 267) were high risk, with the mean risk scores being 0.12±0.01 (95% CI 0.0 to 0.47) and 1.68±0.91 (95% CI 0.52 to 13.19), respectively. Within the low risk group, 130 of 239 (54%) were investigated for EOS, while 31 of 239 (13%) received antibiotics. Within the high risk group, 18 of 28 (64%) were investigated with only two of 28 (7%) also being treated for EOS. There were no differences in the mean risk scores in the high risk group between those who were investigated and those who were not. The scores of the two patients in the high risk group who received antibiotics were 13.19 and 0.94, and the mean score of those who did not was 1.26±0.39 (95% CI 0.52 to 4.47). In total, 148 of 267 (55.4%) of infants were investigated for EOS in this cohort based on clinical judgement. No cases of EOS as defined by a positive blood or CSF culture were identified during this period. Use of the Puopolo et al. neonatal sepsis predictive model for evaluation of EOS would have resulted in 81% fewer infants investigated. Costs associated with the investigations and treatment and potential cost savings of using this model are currently being evaluated. Prospective study is needed to further evaluate the practical impact of this predictive instrument on EOS identification and associated cost savings in Canadian NICUs.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».