Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A systematic review and meta-analysis eClinicalMedicine

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A systematic review and meta-analysis eClinicalMedicine


Therefore, we do not have data related to out-of-system hospital readmissions. We used the CDC national incidence of EOS (0.5 per 1,000 live births). Injection site reactions occurred at a rate of 2.2% in patients treated with FASENRA compared with 1.9% in patients treated with placebo. If the calculator were to be adopted in the UK, current postnatal care would have to be adapted. For example, if a baby who would have qualified for observations due to one risk factor as per NICE has a low EOS risk score, would they be allowed to go home after 6 h? Clearly, robust local policies would need to be drawn up on exactly how the calculator were to be used.

  • “Approximately six months after standardizing antibiotic treatment course durations, we knew if we adopted the SRC it would continue to improve consistency of practice within the pediatric groups.
  • The remaining 228 infants did not require admission to the NICU based on their risk assessment using the online calculator.
  • EOS calculator has been proven to be an effective tool for treatment decision-making of neonatal EOS, however we have shown a further decrease in antibiotics administration through a continuous evidence-based update of local guidelines.
  • You should conduct your own research and do proper analysis before investing in any cryptocurrency.
  • The timing of examinations to record clinical signs are the same in risk and non-risk infants.
  • Strengths of our systematic review include an exhaustive search strategy, systematic data extraction and analysis following an a priori specified and registered protocol, and surveying of authors of included studies to ensure completeness of data.

Use the guidance below to optimize blood culture collection whenever it is indicated. When empiric antibiotics are recommended by the SRC, draw a blood culture, and utilize ampicillin and gentamicin. Several approaches have been suggested for the management of newborns at-risk for EOS, but the recent literature highlighted some limitations that are consistent with the results we found in this study. Combining the EOS Calculator and the Universal SPE approach was effective at minimizing some of the risks without increasing any adverse effects.

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A systematic review and meta-analysis

For all these reasons, it is important to avoid unnecessary eos calculator administration to patients during the early post-natal period . However, the clinical diagnosis of sepsis is challenging for neonatologists because many signs of sepsis are nonspecific and are observed with other non-infectious NEAR conditions . On the other side, low-level bacteremia (4 colony-forming units/mL or less), inadequate blood specimens or maternal antibiotic treatment before or during delivery may result in negative blood cultures . It has been estimated that the incidence of culture-negative EOS is 6 to 16 times higher than that of culture-confirmed EOS .

“Approximately six months after standardizing antibiotic treatment course durations, we knew if we adopted the SRC it would continue to improve consistency of practice within the pediatric groups. All parents of infants involved have signed consent for routine care data collection at birth. Absolute frequencies for qualitative data and means for quantitative data were used to describe the demographic characteristics of the sample. Then, the differences between the three time periods were evaluated using 2 tests for qualitative data and analysis of variance with one between-factor for quantitative data. 💡 Another white blood cell calculator that might be useful to you is our ANC calculator without bands. The calculated absolute eosinophil count is expressed in thousands of cells per microlitre (10³ cells/μL).

EOS to EUR Converter

All studies found a lower RR for antibiotic therapy, favoring use of the EOS calculator (range, 3%-60%) . Studies evaluating the EOS calculator in newborns born to mothers with the risk factor of chorioamnionitis reported stronger reductions (RR, 3%-39%) compared with studies not limited to chorioamnionitis (RR, 25%-60%). Within our hospital system, all infants born to mothers with chorioamnionitis were directly admitted to the neonatal intensive care unit for evaluation and treatment of presumed sepsis for a minimum of 48 hours, regardless of clinical appearance. Implementation of a risk-stratification system for thesWe high-risk infants based on the early onset sepsis calculator may decrease NICU admissions and antibiotics exposure in well-appearing neonates. Infants who were considered well and remained in the newborn nursery were followed with vital signs every 4 hours to evaluate for physiologic abnormalities.

To investigate whether the use of the EOS calculator reduces antibiotic exposure in newborns with suspected EOS in the first 24 hours after birth. We used the GRADE tool to estimate the quality of evidence, from very low to high.22,23 This estimation was performed separately for the use of empirical antibiotics for EOS and for safety of use of the EOS calculator. To assess the association between management of neonatal EOS guided by the neonatal EOS calculator and reduction in antibiotic therapy for newborns. Where there was uncertainty about whether a case would be ‘missed’ or not, the authors were contacted for further details and clarification. Determining which babies should receive antibiotics for potential early onset sepsis is challenging. We performed a meta-analysis quantifying how many EOS cases might be ‘missed’ using the Kaiser Permanente electronic calculator, compared with National Institute for Health and Care Excellence guidelines.

The eos calculator of bias across studies (“publication bias”) was not statistically assessed. Once duplicates were removed, the abstracts of all the articles from the search were reviewed independently by two authors , discussing any differences. We searched Medline, MEDIRS and Embase for each author’s publications since 2011 for any additional papers. Clinicians known to be using the calculator were contacted and asked to share data.

They are white blood cells specialized in fighting parasites and certain diseases. This study was approved by the IRB as a quality improvement project at University Hospitals Cleveland Medical Center in Cleveland, Ohio. All information/data provided on our website is only for general information.

Absolute eosinophil count

The of bias was assessed for each included study using QUADAS-2 risk of bias assessment tool, see Table 3 and Supplementary table S2. De Tejada B.M., Pfister R.E., Renzi G., François P., Irion O., Boulvain M., Schrenzel J. Intrapartum Group B streptococcus detection by rapid polymerase chain reaction assay for the prevention of neonatal sepsis. Vaccina E., Luglio A., Ceccoli M., Lecis M., Leone F., Zini T., Toni G., Lugli L., Lucaccioni L., Iughetti L., et al. Brief comments on three existing approaches for managing neonates at risk of early-onset sepsis. Hofer N., Müller W., Resch B. Non-infectious conditions and gestational age influence C-reactive protein values in newborns during the first 3 days of life. Berardi A., Fornaciari S., Rossi C., Patianna V., Reggiani M.L.B., Ferrari F., Neri I., Ferrari F. Safety of physical examination alone for managing well-appearing neonates ≥35 weeks’ gestation at risk for early-onset sepsis.

The search for and verification of missing data were performed using a variety of techniques . Data Availability StatementThe data presented in this study are available on request from the corresponding author.

This meta-analysis has demonstrated that a large proportion of true cases of EOS are ‘missed’ by the calculator, in addition to those which would be missed by NICE guidelines. The probability of missing additional cases compared to the NICE guidelines is significantly higher amongst babies exposed NEAR to chorioamnionitis. The proportion of cases of EOS which would have been ‘missed’, or where treatment would have been delayed by using the calculator, were compared to NICE guidelines. We considered any baby with positive blood cultures and an EOS risk score of Tables 1 and 2). Any cases where treatment was not recommended by the calculator, but this was concordant with NICE guidelines, were not classified as a ‘miss’.

The number of cases of EOS on which the calculator has been tested has not reached the threshold for effective external validation. Early onset sepsis is a rare but significant cause of mortality and morbidity in neonates. Current guidelines lead to large numbers of well babies receiving antibiotics.


This cannot be true however since the advertisements for the EOS calculator already appeared in 1927, and the company was present at the Schweizer Mustermesse in 1926. It therefore seems more likely that the EOS was a licensed version of the CK. It is not clear whether any Hannovera parts were used, especially at first, or whether it was completely manufactured by EOS. The case of the calculator states that it was manufactured in Switzerland so at least some of it was made there. The EOS calculator was made by the EOS-Genossenschaft für Fabrikation und Vertrieb von Rechenmaschinen, based in Zürich at Albisstraße 2. The EOS was virtually identical to the Hannovera CK, except that the case has an EOS logo.

Of these deliveries, 200 are affected by chorioamnionitis, and 75 are affected by maternal fever without chorioamnionitis. We used The Model for Improvement as a framework for designing this initiative. Participants were inborn infants 35 weeks and older born to mothers with chorioamnionitis and/or fever.

Help your patients get the most out of what FASENRA has to offer. Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals. There was sufficient data to incorporate it into the meta-analysis. ] because we were unable to determine which cases would have been missed. 1 case in each epoch, both were clinically unwell requiring admission to the neonatal unit.

How high is too high for EOS?

A count of more than 500 eosinophils per microliter of blood is generally considered eosinophilia in adults. A count of more than 1,500 eosinophils per microliter of blood that lasts for several months is called hypereosinophilia.

The absolute eosinophil count is a test similar to the total blood count, where the target is the number of eosinophil cells in a given blood sample. The state of eosinophil count elevation over 0.45 × 10³ cells/μL is called eosinophilia and is linked to allergic reactions and parasitic infections. In clinical trials in patients receiving NUCALA, the most common adverse reactions (≥5%) were headache, injection site reaction, back pain, and fatigue. Manifestations included rash, pruritus, headache, myalgia, and flushing; the majority were experienced the day of dosing. Treat patients with pre-existing helminth infections before initiating therapy with NUCALA. If patients become infected while receiving NUCALA and do not respond to anti-helminth treatment, discontinue NUCALA until infection resolves.

The primary outcome measure was numbers of culture positive EOS cases where the calculator did not recommend empirical antibiotics, but NICE guidelines would have. A subgroup analysis was performed using data from studies of babies exposed to chorioamnionitis. Over half of the initially well-appearing infants (54%), who subsequently required transfer to the NICU, presented with temperature instability.

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A … – The Lancet

Sensitivity of the Kaiser Permanente early-onset sepsis calculator: A ….

Posted: Sun, 22 Dec 2019 08:00:00 GMT [source]