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Interrater Reliability of Surveillance for Ventilator-Associated Events and Pneumonia

Published online by Cambridge University Press:  08 November 2016

Meeta Prasad Kerlin ,
William E. Trick ,
Deverick J. Anderson ,
Hilary M. Babcock ,
Ebbing Lautenbach ,
Renaud Gueret  and
Michael Klompas
Meeta Prasad Kerlin*
Affiliation:
Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
William E. Trick
Affiliation:
Collaborative Research Unit, Cook County Health and Hospitals Systems, Chicago, Illinois
Deverick J. Anderson
Affiliation:
Duke Center for Healthcare Epidemiology, Duke University, Durham, North Carolina
Hilary M. Babcock
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
Ebbing Lautenbach
Affiliation:
Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Renaud Gueret
Affiliation:
Collaborative Research Unit, Cook County Health and Hospitals Systems, Chicago, Illinois
Michael Klompas
Affiliation:
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
*
Address correspondence to Meeta Prasad Kerlin, Perelman School of Medicine at the University of Pennsylvania, 3600 Spruce St, Gibson 5011, Philadelphia, PA 19104 (prasadm@uphs.upenn.edu).
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Abstract

OBJECTIVE

To compare interrater reliabilities for ventilator-associated event (VAE) surveillance, traditional ventilator-associated pneumonia (VAP) surveillance, and clinical diagnosis of VAP by intensivists.

DESIGN

A retrospective study nested within a prospective multicenter quality improvement study.

SETTING

Intensive care units (ICUs) within 5 hospitals of the Centers for Disease Control and Prevention Epicenters.

PATIENTS

Patients who underwent mechanical ventilation.

METHODS

We selected 150 charts for review, including all VAEs and traditionally defined VAPs identified during the primary study and randomly selected charts of patients without VAEs or VAPs. Each chart was independently reviewed by 2 research assistants (RAs) for VAEs, 2 hospital infection preventionists (IPs) for traditionally defined VAP, and 2 intensivists for any episodes of pulmonary deterioration. We calculated interrater agreement using κ estimates.

RESULTS

The 150 selected episodes spanned 2,500 ventilator days. In total, 93–96 VAEs were identified by RAs; 31–49 VAPs were identified by IPs, and 29–35 VAPs were diagnosed by intensivists. Interrater reliability between RAs for VAEs was high (κ, 0.71; 95% CI, 0.59–0.81). Agreement between IPs using traditional VAP criteria was slight (κ, 0.12; 95% CI, −0.05–0.29). Agreement between intensivists was slight regarding episodes of pulmonary deterioration (κ 0.22; 95% CI, 0.05–0.39) and was fair regarding whether episodes of deterioration were attributable to clinically defined VAP (κ, 0.34; 95% CI, 0.17–0.51). The clinical correlation between VAE surveillance and intensivists’ clinical assessments was poor.

CONCLUSIONS

Prospective surveillance using VAE criteria is more reliable than traditional VAP surveillance and clinical VAP diagnosis; the correlation between VAEs and clinically recognized pulmonary deterioration is poor.

Infect Control Hosp Epidemiol 2017;38:172–178

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 2 , February 2017 , pp. 172 - 178
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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