# Impact of Physician Characteristics on Late-Onset Sepsis (LOS) Evaluation in the NICU

## TL;DR

This study examines how physician characteristics influence late-onset sepsis evaluations in neonatal intensive care units.

## Contribution

It identifies that physician race, gender, and immigration status affect clinical decisions during sepsis evaluations.

## Key findings

- Experienced physicians were more likely to obtain a CBC during LOS evaluations.
- Race, gender, and immigration status influenced whether CRP was included in evaluations.
- Other physician characteristics did not affect the likelihood of bacteremia or overall LOS evaluation decisions.

## Abstract

The threshold for a late-onset sepsis (LOS) evaluation varies considerably across NICUs. This unexplained variability is probably related in part to physician bias regarding when sepsis should be “ruled out”. The aim of this study is to determine if physician characteristics (race, gender, immigration status, years of experience and academic rank) effect LOS evaluation in the NICU. This study includes a retrospective chart review of all Level III NICU infants who had a LOS evaluation over 54 months. Physician characteristics were compared between positive and negative blood culture groups and whether CBC and CRP were obtained at LOS evaluations. 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 of [median (Q1, Q3)]+ 992 (720, 1820) grams and birth gestation of [median (Q1, Q3)] 276/7 (252/7, 330/7) weeks. There are 10 neonatologists in the group, 5/10 being female and 6/10 being immigrant physicians. Experienced physicians were more likely to obtain a CBC at the time of LOS evaluation. Physician characteristics of race, gender and immigration status impacted whether to include a CRP as part of a LOS evaluation but otherwise did not influence LOS evaluation, including the likelihood of bacteremia.