title: Utility of Decision Rules for Transcutaneous Bilirubin Measurements.
abstract: Transcutaneous bilirubin (TcB) meters are widely used for screening newborns for jaundice, with a total serum bilirubin (TSB) measurement indicated when the TcB value is classified as "positive" by using a decision rule. The goal of our study was to assess the clinical utility of 3 recommended TcB screening decision rules.
  
  
  
  Paired TcB/TSB measurements were collected at 34 newborn nursery sites. At 27 sites (sample 1), newborns were routinely screened with a TcB measurement. For sample 2, sites that typically screen with TSB levels also obtained a TcB measurement for the study. Three decision rules to define a positive TcB measurement were evaluated: ≥75th percentile on the Bhutani nomogram, 70% of the phototherapy level, and within 3 mg/dL of the phototherapy threshold. The primary outcome was a TSB level at/above the phototherapy threshold. The rate of false-negative TcB screens and percentage of blood draws avoided were calculated for each decision rule.
  
  
  
  For sample 1, data were analyzed on 911 paired TcB-TSB measurements from a total of 8316 TcB measurements. False-negative rates were <10% with all decision rules; none identified all 31 newborns with a TSB level at/above the phototherapy threshold. The percentage of blood draws avoided ranged from 79.4% to 90.7%. In sample 2, each rule correctly identified all 8 newborns with TSB levels at/above the phototherapy threshold.
  
  
  
  Although all of the decision rules can be used effectively to screen newborns for jaundice, each will "miss" some infants with a TSB level at/above the phototherapy threshold.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, Washington; uncjat@uw.edu.
authors.forename: James A
authors.initials: JA
authors.lastname: Taylor
authors.affiliation: Kaiser Permanente, Downey, California;
authors.forename: Anthony E
authors.initials: AE
authors.lastname: Burgos
authors.affiliation: Department of Pediatrics, University of California San Francisco, San Francisco, California;
authors.forename: Valerie
authors.initials: V
authors.lastname: Flaherman
authors.affiliation: Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University and Nemours, Philadelphia, Pennsylvania;
authors.forename: Esther K
authors.initials: EK
authors.lastname: Chung
authors.affiliation: Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri;
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Simpson
authors.affiliation: Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio;
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.affiliation: Holy Cross Health, Silver Spring, Maryland; and.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Von Kohorn
authors.affiliation: Academic Pediatric Association, McLean, Virginia.
authors.forename: Niramol
authors.initials: N
authors.lastname: Dhepyasuwan
mesh_terms: D001663:Bilirubin / Q000097:blood*; D001774:Blood Chemical Analysis / Q000295:instrumentation / Q000379:methods; D003661:Decision Support Techniques; D004867:Equipment Design; D005188:False Negative Reactions; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000097:blood / Q000175:diagnosis*; D015997:Neonatal Screening / Q000379:methods*; D012867:Skin
chemical_list: D001663:Bilirubin