Retrospective identification of infection in the emergency department: A significant challenge in sepsis clinical trials.

Autor:	O'Neal CS; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA. Electronic address: coneal@lsuhsc.edu., Hamer D; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA., Musso MW; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program, Baton Rouge, LA, USA., Caffery TS; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program, Baton Rouge, LA, USA., Walker MK; National Institutes of Health, Bethesda, MD, USA., Lavie KW; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA., Berlinger MS; Department of Medicine, Johns Hopkins University, Baltimore, MD, USA., Thomas CB; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Baton Rouge General Medical Center, Baton Rouge, LA, USA., Alwood SM; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program, Baton Rouge, LA, USA., Jagneaux T; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Baton Rouge General Medical Center, Baton Rouge, LA, USA., Sanchez MA; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Baton Rouge General Medical Center, Baton Rouge, LA, USA., O'Neal HR; Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA; Baton Rouge General Medical Center, Baton Rouge, LA, USA.
Jazyk:	angličtina
Zdroj:	The American journal of the medical sciences [Am J Med Sci] 2022 Aug; Vol. 364 (2), pp. 163-167. Date of Electronic Publication: 2022 Mar 14.
DOI:	10.1016/j.amjms.2022.02.008
Abstrakt:	Background: This study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior. Methods: This study used a subset of data from a prospective sepsis trial. We used Fleiss's Kappa to compare agreement between two physicians retrospectively adjudicating infection based on the patient's medical record, modified infection definition from the CDC/NHSN, and ED treating physician behavior. Results: Overall, there was similar agreement between physician adjudication of infection and MODI criteria (Kappa=0.59) compared to having two physicians independently identify infection through retrospective chart review (Kappa=0.58). ED treating physician behavior was a poorer proxy for infection when compared to the MODI criteria (0.41) and physician adjudication (Kappa = 0.50). Conclusions: Retrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart. Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to declare. (Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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