Retrospective Identification of Infection in the Emergency Department: A Significant Challenge in Sepsis Clinical Trials.

Mar 21, 2022

Contributor: Catherine S O'Neal,Diana Hamer,Mandi W Musso,Terrell S Caffery,Morgan K Walker,Katherine W Lavie,Matthew S Berlinger,Christopher B Thomas,Shannon M Alwood,Tonya Jagneaux,Michael A Sanchez,Hollis R O'Neal

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.
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.
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).
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.

Copyright © 2022. Published by Elsevier Inc.

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About The Expert

Catherine S O’Neal

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808.

Diana Hamer

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808.

Mandi W Musso

Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808.

Terrell S Caffery

Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808.

Morgan K Walker

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808.

Katherine W Lavie

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808.

Matthew S Berlinger

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808.

Christopher B Thomas

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809.

Shannon M Alwood

Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Louisiana State University Health Sciences Center, Emergency Medicine Residency Program 5246 Brittany Dr., Baton Rouge, LA, USA 70808.

Tonya Jagneaux

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809.

Michael A Sanchez

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809.

Hollis R O’Neal

Louisiana State University Health Sciences Center, Internal Medicine Residency Program, 5246 Brittany Dr., Baton Rouge, LA, USA 70808; Our Lady of the Lake Regional Medical Center, 5000 Hennessey Blvd., Baton Rouge, LA, USA 70808; Baton Rouge General Medical Center, 8585 Picardy Ave., Baton Rouge, LA, USA 70809.

References

PubMed