465 - Impact of physician characteristics on evaluations for late onset sepsis (LOS)

Poster Number: 465
Publication Number: 465.432

Harshkumar Patel, Southern Illinois University School of Medicine, Springfield, IL, United States; Blaine Traylor, Southern Illinois University School of Medicine, Springfield, IL, United States; Mohamed F. Ahamed, Southern Illinois University School of Medicine, Springfield, IL, United States; Ginger Darling, SIU School of Medicine, Springfield, IL, United States; Erin Bauer, Southern Illinois University School of Medicine, Springfield, IL, United States; Albert Botchway, Southern Illinois University School of Medicine, Springfield, IL, United States; Beau Batton, SIU, Springfield, IL, United States; Venkata S. Majjiga, Southern Illinois University School of Medicine, Springfield, IL, United States

Background: Between 10 to 30% of very low birth weight (VLBW) infants develop LOS. The threshold for a LOS evaluation varies considerably across NICUs and this variability cannot be explained by the baseline incidence in LOS or demographic data associated with increased morbidity and mortality risks. This unexplained variability is probably related in part to the lack of objective data associated with a positive blood culture in LOS as well as physician bias regarding when sepsis should be “ruled-out”. We hypothesize that physician characteristics influence the decision to perform a LOS evaluation in the NICU.

Objective: To determine if physician characteristics effect LOS evaluation in the NICU.

Design/Methods: This study includes a retrospective chart review of all level III NICU (Average daily census: 40; >800 admissions annually) infants who had a LOS evaluation over 54 months (3/18/2018 through 9/30/2022). Physician characteristics were compared between a positive and a negative blood culture in LOS evaluations, and whether physician characteristics differed in doing CBC and CRP at LOS evaluations.

Results: There were 341 LOS evaluations performed during the study period. Two patients were excluded due to a contaminant. Patients in this study had a birth weight [Median (Q1, Q3)] 992 (720, 1820) grams and birth gestation [Median (Q1, Q3)] 27 ^6/7(25^2/7, 33) weeks. There are 10 neonatologists in the group, 50% female and 70% immigrant physicians. Experienced physicians were more likely to obtain a CBC at the time of LOS evaluation (table 1). Physician race, gender, and immigration status impacted the decision to include a CRP with a LOS evaluation (table 2). No physician characteristics were associated with an increased likelihood of a positive blood culture at the time of LOS evaluation (table 3).

Conclusion(s): Physician characteristics impacted whether to include a CRP as part of a LOS evaluation, but otherwise did not influence LOS evaluation, including the likelihood of bacteremia.