Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections 英文参考文献.docVIP

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Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections 英文参考文献.doc

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Agreement among Health Care Professionals in Diagnosing Case Vignette-Based Surgical Site Infections 英文参考文献

AgreementamongHealthCareProfessionalsin DiagnosingCaseVignette-BasedSurgicalSiteInfections DidierLepelletier1,2,PhilippeRavaud3,4,5,GabrielBaron3,4,5,Jean-ChristopheLucet 1,2 ¤ * 1InfectionControlUnit,Bichat-ClaudeBernardHospital,AssistancePublique-Ho?pitauxdeParis,Paris,France,2UniversityParisDiderot,SorbonneParisCite′,Paris,France, 3Ho?tel Dieu, Centre d’E′pide′miologie Clinique, Assistance Publique des Ho?pitaux de Paris, Paris, France, 4INSERM, U738, Paris, France, 5University Paris Descartes, SorbonneParisCite′,Paris,France Abstract Objective:Toassessagreementindiagnosingsurgicalsiteinfection(SSI)amonghealthcareprofessionalsinvolvedinSSI surveillance. Methods: Case-vignette study done in 2009 in 140 healthcare professionals from seven specialties (20 in each specialty, Anesthesiologists, Surgeons, Public health specialists, Infection control physicians, Infection control nurses, Infectious diseases specialists, Microbiologists) in 29 University and 36 non-University hospitals in France. We developed 40 case- vignettesbasedoncardiacandgastrointestinalsurgerypatientswithsuspectedSSI.Eachparticipantscoredsixrandomly assignedcase-vignettesbeforeandafterreadingtheSSIdefinitiononanonlinesecurerelationaldatabase.Theintraclass correlation coefficient (ICC)wasused to assess agreement regardingSSI diagnosis onaseven-point Likertscale andthe kappacoefficienttoassessagreementforsuperficialordeepSSIonathree-pointscale. Results: Basedon aconsensus, SSIwas presentin21 of40 vignettes(52.5%).Intraspecialty agreement forSSI diagnosis rangedacrossspecialtiesfrom0.15(95%confidenceinterval,0.00–0.59)(anesthesiologistsandinfectioncontrolnurses)to 0.73(0.32–0.90)(infectiousdiseasesspecialists).ReadingtheSSIdefinitionimprovedagreementinthespecialtieswithpoor initial agreement. Intraspecialty agreement for superficial or deep SSI ranged from 0.10 (20.19–0.38) to 0.54 (0.25–0.83) (surgeons)andincreasedafterreadingtheSSIdefinitiononlyamongtheinfectioncontrolnursesfrom0.10(20.19–0.38)to