Identifying neonatal early-onset sepsis test and treatment decision thresholds

Objective: To derive testing and treatment thresholds for early-onset neonatal sepsis and compare them to thresholds used in the Kaiser-Permanente (KP) Sepsis Calculator. Methods: Using surveys distributed in the United States, Brazil and Italy, decision thresholds were derived via self-identified thresholds selected from structured lists (Method 1), and based on clinical vignette responses for testing and treatment with or without inclusion of associated relative risk (Methods 2 and 3). Results: Using Method 1, both testing and treatment thresholds were higher than the KP calculator thresholds. Test thresholds were lower (Method 2) or equivalent (Method 3) to KP using clinical vignettes. No vignette reached the 50% cutoff necessary to define a treatment threshold. Conclusion: The test threshold used by the KP calculator is the same as the threshold chosen by clinicians given a vignette and risk estimate. The KP treatment threshold is lower than that derived using all 3 methods.