6777 Sepsis risk calculator: has there been a sustained outcome change in North Wales?

Objectives The Kaiser Permanente Sepsis Risk Calculator (SRC)¹ has been used in Wales since March 2019 to identify, test and treat babies at risk of early onset neonatal sepsis (EONS). It was projected that application of SRC would reduce antibiotic use by ≈50%.² This study analysed this prediction by ascertaining the rates of EONS diagnostic work up over an eight-year period at the three North Wales neonatal units. Methods Blood cultures were used as an absolute measure of number of EONS tests performed. Welsh Laboratory Information Management System (WLIMS) was used to retrieve all instances of blood culture taken in babies within the first 24 hrs of age in each of the three neonatal units in North Wales, comprising of two Special Care Baby Units (SCBU) and one Sub-regional neonatal intensive care centre (SurNICC): all constituents of one NHS trust. Data could only be reliably obtained from 2015 onwards as WLIMS lost support of the legacy pathology information system. The numbers of live birth in each of the hospitals were obtained through maternity information database. The rate of EONS tests was expressed as the proportion of live born babies undergoing blood culture testing in the first 24 hrs of age. Trends before and after introduction of SRC were analysed. The Mann-Whitney test was used for statistical analysis. Results Since the introduction of SRC, two SCBUs have seen a decline in proportion of blood cultures performed from ≈9% at a peak in 2017 to 6–7% (p<.001), but the rate remained unchanged at 9–10% in SurNICC (figure 1). The data also showed that the rate of blood cultures increased from 2015 to a peak in 2017, and then appeared to decline in both SCBUs prior to the introduction of SRC in 2019. Conclusion Given the rate of blood cultures for suspected EONS in 2015 was similar to the rate from 2019 onwards, and given the lack of change in SurNICC, further study is required to elucidate the impact of SRC on the rate of EONS diagnostic work up and treatment. References Kaiser Permanente. Kaiser Permanente Research website 2023. accessed 9th October 2023, < https://neonatalsepsiscalculator.kaiserpermanente.org/> Goel N, Shrestha S, Smith R, et al. Screening for early onset neonatal sepsis: NICE guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population. Archives of Disease in Childhood – Fetal and Neonatal Edition 2020;105:118–122.