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Abstract

Introduction

The contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings. The European Centre for Disease Prevention and Control recently introduced MR into its HAI surveillance.

Aim

We evaluate validity and reproducibility of three MR measures.

Methods

The on-site investigator, usually an infection prevention and control doctor, and the clinician in charge of the patient independently reviewed records of deceased patients with bloodstream infection (BSI), pneumonia, infection (CDI) or surgical site infection (SSI), and assessed the contribution to death using 3CAT: definitely/possibly/no contribution to death; WHOCAT: sole cause/part of causal sequence but not sufficient on its own/contributory cause but unrelated to condition causing death/no contribution, based on the World Health Organization’s death certificate; QUANT: Likert scale: 0 (no contribution) to 10 (definitely cause of death). Inter-rater reliability was assessed with weighted kappa (wk) and intra-cluster correlation coefficient (ICC). Reviewers rated the fit of the measures.

Results

From 2017 to 2018, 24 hospitals (11 countries) recorded 291 cases: 87 BSI, 113 pneumonia , 71 CDI and 20 SSI. The inter-rater reliability was: 3CAT wk 0.68 (95% confidence interval (CI): 0.61–0.75); WHOCAT wk 0.65 (95% CI: 0.58–0.73); QUANT ICC 0.76 (95% CI: 0.71–0.81). Inter-rater reliability ranged from 0.72 for pneumonia to 0.52 for CDI. All three measures fitted ‘reasonably’ or ‘well’ in > 88%.

Conclusion

Feasibility, validity and reproducibility of these MR measures was acceptable for use in HAI surveillance.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2021-06-10
2024-12-22
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Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Tjallie+van+der+Kooi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">van der Kooi Tjallie</a>, <a href="/search?value1=Alain+Lepape&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lepape Alain</a>, <a href="/search?value1=Pascal+Astagneau&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Astagneau Pascal</a>, <a href="/search?value1=Carl+Suetens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Suetens Carl</a>, <a href="/search?value1=Mioara+Alina+Nicolaie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Nicolaie Mioara Alina</a>, <a href="/search?value1=Sabine+de+Greeff&option1=author&noRedirect=true" class="nonDisambigAuthorLink">de Greeff Sabine</a>, <a href="/search?value1=Ilma+Lozoraitiene&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Lozoraitiene Ilma</a>, <a href="/search?value1=Jacek+Czepiel&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Czepiel Jacek</a>, <a href="/search?value1=M%C3%A1rta+Patyi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Patyi Márta</a>, <a href="/search?value1=Diamantis+Plachouras&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Plachouras Diamantis</a>, <a href="/search?value1=the+HAI-Net+Mortality+review+study+group&option1=author&noRedirect=true" class="nonDisambigAuthorLink">the HAI-Net Mortality review study group</a></span>. Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018. <a href="/content/ecdc">Euro Surveill.</a> 2021;26(23):pii=2000052. <a href="https://doi.org/10.2807/1560-7917.ES.2021.26.23.2000052" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2021.26.23.2000052</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 23 Jan 2020;&nbsp;&nbsp; <span class="generated">Accepted</span>: 18 Dec 2020 </span> </p>
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