American Journal of the Medical Sciences
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.
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O'Neal, Catherine S.; Hamer, Diana; Musso, Mandi W.; Caffery, Terrell S.; Walker, Morgan K.; Lavie, Katherine W.; Berlinger, Matthew S.; Thomas, Christopher B.; Alwood, Shannon M.; Jagneaux, Tonya; Sanchez, Michael A.; and O'Neal, Hollis R., "Retrospective Identification Of Infection In The Emergency Department: A Significant Challenge In Sepsis Clinical Trials" (2022). School of Medicine Faculty Publications. 698.