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1186 Does Availability of Interleukin-6 Results Influence Clinical Decision Making in Neonatal Sepsis?
  1. S Babarao1,2,
  2. L Miall1
  1. 1Neonatal Unit, Leeds Teaching Hospitals NHS Trust
  2. 2School of Paediatrics, University of Leeds, Leeds, UK

Abstract

Backround and aims Clinical diagnosis of neonatal sepsis has always been challenging. Recent studies have suggested that Interleukin-6 assays can be useful in diagnosis of sepsis alongside CRP. This study looks at the influence of IL-6 and CRP results on clinical decision making.

Methods A prospective web-based questionnaire survey of both junior doctors (online survey) and Consultants (focus group) was carried out using 20 hypothetical scenarios of neonatal sepsis along with hypothetical IL-6 and CRP results. The differences in diagnostic certainty of sepsis on the basis of clinical history alone were compared with that of addition of CRP and IL-6 results, within and between both the trainee and expert groups. (Expert group consensus responses were considered as gold-standard).

Results Experts: Based on clinical history, CRP and IL-6 results, experts agreed to the possibility of sepsis in only 25% of the clinical situations. Antibiotic usage by experts subsequent to sepsis categorisation was reduced with the availability of CRP results. (55% after IL-6 vs. 30% after CRP results).

Trainees: CRP results were shown to be statistically significant in changing clinician’s decisions. Trainees favoured a greater likelihood of sepsis when IL-6 results were available prior to CRP results. Using the focus group consensus as gold standard, IL-6 results were used by trainees for confirming sepsis irrespective of whether they were available prior to or after CRP results.

Conclusion Both point-of-care IL-6 test results and CRP results helped doctors in confirming a diagnosis of sepsis. IL-6 was not useful in ruling out sepsis.

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