scholarly journals Structure, Process, and Outcome Quality of Surgical Site Infection Surveillance in Switzerland

2017 ◽  
Vol 38 (10) ◽  
pp. 1172-1181 ◽  
Author(s):  
Stefan P. Kuster ◽  
Marie-Christine Eisenring ◽  
Hugo Sax ◽  
Nicolas Troillet ◽  
Keyword(s):  
Positive Predictive Value ◽  
Surgical Site Infection ◽  
Negative Predictive Value ◽  
Random Sample ◽  
Predictive Value ◽  
Chart Review ◽  
Patient Records ◽  
Site Infection ◽  
Validation Score

OBJECTIVETo assess the structure and quality of surveillance activities and to validate outcome detection in the Swiss national surgical site infection (SSI) surveillance program.DESIGNCountrywide survey of SSI surveillance quality.SETTING147 hospitals or hospital units with surgical activities in Switzerland.METHODSSite visits were conducted with on-site structured interviews and review of a random sample of 15 patient records per hospital: 10 from the entire data set and 5 from a subset of patients with originally reported infection. Process and structure were rated in 9 domains with a weighted overall validation score, and sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the identification of SSI.RESULTSOf 50 possible points, the median validation score was 35.5 (range, 16.25–48.5). Public hospitals (P<.001), hospitals in the Italian-speaking region of Switzerland (P=.021), and hospitals with longer participation in the surveillance (P=.018) had higher scores than others. Domains that contributed most to lower scores were quality of chart review and quality of data extraction. Of 49 infections, 15 (30.6%) had been overlooked in a random sample of 1,110 patient records, accounting for a sensitivity of 69.4% (95% confidence interval [CI], 54.6%–81.7%), a specificity of 99.9% (95% CI, 99.5%–100%), a positive predictive value of 97.1% (95% CI, 85.1%–99.9%), and a negative predictive value of 98.6% (95% CI, 97.7%–99.2%).CONCLUSIONSIrrespective of a well-defined surveillance methodology, there is a wide variation of SSI surveillance quality. The quality of chart review and the accuracy of data collection are the main areas for improvement.Infect Control Hosp Epidemiol 2017;38:1172–1181

scholarly journals Drain Tip Culture: Would It Help Us Predict and Prevent Surgical Site Infection After Spinal Surgery?

2021 ◽  
Vol 2 (1) ◽  
Keyword(s):  
Positive Predictive Value ◽  
Surgical Site Infection ◽  
Negative Predictive Value ◽  
Spine Surgery ◽  
Predictive Value ◽  
Spinal Surgery ◽  
Statistical Significance ◽  
High Specificity ◽  
Site Infection ◽  
Low Sensitivity

Background: Systematic cultures of drain tips or drainage fluids are commonly used by surgical teams for the early detection of Surgical Site Infection (SSI), even in the absence of clinical suspicion of infection. However, their prognostic values are controversial. Method: This was a prospective study of patients undergoing spine surgery at our institute during the study period. Patients already diagnosed with spine infection were excluded from the study. At the time of drain removal, the drain tip was cut and sent to microbiology laboratory for bacterial culture. All patients were treated with antimicrobial prophylaxis based on evidence-based guidelines and were monitored for at least 6 months after surgery for the development of Surgical Site Infection (SSI). SSI was defined according to Centers for Disease Control and Prevention criteria. Results: The study comprised of 183 patients including 85 males and 98 females. The rate of Surgical Site Infection in our study was 2.73 % (5 patients). Drain Tip Culture (DTC) was positive in 4 patients (2.18 %). Association of DTC with SSI was found to have high Specificity (98.31 %) and Negative Predictive Value (97.76 %) but low Sensitivity (20 %) and Positive Predictive Value (25 %). Conclusion: Culture of drain tip after spine surgery does not conclusively predict the presence or absence of surgical site infection. However, statistical significance was observed between drain tip culture and surgical site infection with high specificity, high negative predictive value, low sensitivity and low positive predictive value. Keywords: Drain tip culture; Spinal Surgery; Surgical site infection.

Validation of Surgical Site Infection Surveillance in The Netherlands

2007 ◽  
Vol 28 (1) ◽  
pp. 36-41 ◽  
Author(s):  
J. Manniën ◽  
A. E. van der Zeeuw ◽  
J. C. Wille ◽  
S. van den Hof
Keyword(s):  
Surgical Site Infection ◽  
Predictive Value ◽  
Medical Records ◽  
Surveillance System ◽  
Structured Interview ◽  
Surveillance Data ◽  
National Nosocomial Infection Surveillance ◽  
Site Infection ◽  
Infection Surveillance

Objectives.To describe how continuous validation of data on surgical site infection (SSI) is being performed in the Dutch National Nosocomial Infection Surveillance System (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), to assess the quality and accuracy of the PREZIES data, and to present the corresponding outcomes of the assessment.Design.Mandatory, 1-day on-site validation visit to participating hospitals every 3 years. The process of surveillance, including the quality of the method of data collection, is validated by means of a structured interview. The use of SSI criteria is validated by review of medical records, with the judgment of the validation team as the criterion standard.Setting.Hospitals participating in PREZIES.Results.During 1999-2004, the validation team visited 40 hospitals and reviewed 859 medical charts. There was no deviation between reports of SSI by infection control professionals and findings by the PREZIES validation team at 30 hospitals and 1 deviation in each of 10 hospitals; the positive predictive value was 0.97, and the negative predictive value was 0.99. The validation team often gave advice to the hospital, aimed at perfecting the process of surveillance. On 2 occasions, data were removed from the PREZIES database after the validation visit revealed deviations from the SSI surveillance protocol that could have resulted in nonrepresentative SSI rate data.Conclusions.PREZIES is confident that the assembled Dutch SSI surveillance data are reliable and robust and are sufficiently accurate to be used as a reference for interhospital comparison. PREZIES will continue performing on-site validation visits, to improve the process of surveillance and ensure the reliability of the surveillance data.

Initial implementation of an electronic oncology trigger tool for adverse event detection.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 298-298
Author(s):  
William Lyons
Keyword(s):  
Quality Of Care ◽  
Adverse Events ◽  
Positive Predictive Value ◽  
Predictive Value ◽  
Chart Review ◽  
System Development ◽  
Small Scale ◽  
Trigger Tool ◽  
Trigger Events

298 Background: In 2009, the Institute for Healthcare Improvement (IHI) conceived the Global Trigger Tool (GTT), a method for identifying adverse events that relies on correlated clinical documentation, “triggers”, in the medical record. This method is intended to augment traditional quality of care, data collection initiatives that primarily depend on voluntary reporting or error tracking. However, the original trigger tool called for a manual identification of trigger events and is too broad to be useful in an oncology setting. We propose a method for the development, selection, electronic extraction and management of triggers relevant to an oncology setting, with the primary aim of improving our understanding of the prevalence of adverse events occurring during an inpatient stay. Methods: Our implementation of an Electronic Trigger Tool includes three parts: trigger selection, review system development, and the chart review process. Through literature review, we developed a library of 40 oncology-relevant trigger tools. We then selected two pilot triggers based on expert opinion and a trigger analysis on length of stay, cost, and patient satisfaction. Next, we developed a web-app that allows reviewers to automatically receive trigger events. Finally, two clinical professionals reviewed five trigger events from each trigger for five subsequent weeks. Results: We selected Narcan administration (M9) and unexpected/unplanned ICU admission after non-emergent surgical procedure (S3) as pilot triggers. Our reviewers each performed a chart review on 25 for each trigger, resulting in 100 independent reviews. We found that M9 had a positive predictive value (PPV) of .52 (26 AEs / 50 reviews) and S3 had a positive predictive value of .88 (44 AEs / 50 reviews). We also found that most of these adverse events were not found by other quality systems. Conclusions: Our pilot of two triggers demonstrated we can capture adverse events that exist outside known quality and safety resources on a small scale and with high PPV. We anticipate using novel trigger information to inform process improvement and quality of care for patients with cancer at our hospital.

Erratum to Palareti et al. “The SAME-TT2R2 score predicts the quality of anticoagulation control in patients with acute VTE. A real-life inception cohort study” (Thromb Haemost 2016; 115: 1101-1108)

2016 ◽  
Vol 116 (08) ◽  
pp. 396-396
Keyword(s):  
Cohort Study ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Real Life ◽  
Inception Cohort ◽  
C Statistic ◽  
Anticoagulation Control

In the Original Article “The SAME-TT2R2 score predicts the quality of anticoagulation control in patients with acute VTE. A real-life inception cohort study” (Thromb Haemost 2016; 115: 1101-1108) by Palareti et al. the last sentence at the end of the second paragraph on page 1105 of the article is wrong and should read as follows: “Regarding the ability of the score ≥2 to predict a TTR <65%, the C statistic was 0.52 (95% CI 0.48–0.55; p = 0.35); the sensitivity was 74% (70.4–77.8), specificity 29% (25.3–33.2), negative predictive value 52% (95% CI 45.8–57.7) and positive predictive value 53% (40.0–56.2).” The authors apologise for this error.

scholarly journals High incidence of surgical site infection may be related to suboptimal case selection of non-selective arterioembolisation during resuscitation of patients with pelvic fractures

2020 ◽  
Author(s):  
Chih-Yang Lai ◽  
I-Chuan Tseng ◽  
Chun-Yi Su ◽  
Yung-Heng Hsu ◽  
Ying-Chao Chou ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Surgical Site Infection ◽  
Predictive Value ◽  
Injury Severity ◽  
Standard Procedure ◽  
Pelvic Fractures ◽  
Unstable Fracture ◽  
Site Infection ◽  
Number Of Patients ◽  
High Incidence

Abstract Background In most institutions, arterioembolisation (AE) remains a standard procedure to achieve haemostasis in the resuscitation of patients with pelvic fractures. However, the actual benefits from AE are controversial. Methods We retrospectively reviewed data from patients with closed pelvic fractures between 2014 and 2017 in a single institute. The details of AE and clinical parameters were recorded and analysed to determine whether poor outcomes could be predicted. Results During the study period, 545 patients with closed pelvic fractures were enrolled. Angiography was performed in 131 patients, and 129 patients underwent AE. The patients who underwent AE had higher injury severity score, more numbers of shock status on arrival, and higher incidence of unstable fracture patterns when compared to non-AE group. A higher number of patients who underwent AE required osteosynthesis and experienced surgical site infection (SSI) after osteosynthesis than those who did not receive AE. Nonselective bilateral internal iliac artery embolisation (nBIIAE) was the major approach for AE (74%). Overall, 11 patients experienced SSI in the AE group, 9 of whom had received nBIIAE. The positive predictive value of contrast extravasation (CE) on computed tomography (CT) was 29.6%, with a negative predictive value of 91.3%. Mortality was higher in patients without CE on CT than patients with identifiable CE (30.0% vs. 11.0%, p = 0.03). Conclusion Using the finding of CE on CT examination as a decision for AE is not a reliable indicator because of its low positive predictive value. Considering the high incidence of SSI following nBIIAE, candidates should be carefully selected for this procedure. Other haemostasis procedures such as preperitoneal pelvic packing might be considered for select cases, given the high mortality rate among patients without CE during image studies, relative to patients with identifiable CE.

scholarly journals Added value of diffusion-weighted MRI in assessment of pleural lesions

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Youssriah Yahia Sabri ◽  
Ikram Hamed Mahmoud ◽  
Lamis Tarek El-Gendy ◽  
Mohamed Raafat Abd El-Mageed ◽  
Sally Fouad Tadros
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Diagnostic Value ◽  
Added Value ◽  
Adc Value ◽  
Pleural Diseases ◽  
Conventional Mri ◽  
Malignant Lesions

Abstract Background There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions. Results Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001). Conclusion Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

Accuracy of Medical Examiner’s Assessment for Near–Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017–February 2018

2021 ◽  
pp. 003335492110084
Author(s):  
Kirsten Vannice ◽  
Julia Hood ◽  
Nicole Yarid ◽  
Meagan Kay ◽  
Richard Harruff ◽  
...  
Keyword(s):  
Public Health ◽  
Positive Predictive Value ◽  
Real Time ◽  
Negative Predictive Value ◽  
Drug Overdose ◽  
Predictive Value ◽  
Death Certificate ◽  
King County ◽  
Public Health Response ◽  
Drug Overdoses

Objectives Up-to-date information on the occurrence of drug overdose is critical to guide public health response. The objective of our study was to evaluate a near–real-time fatal drug overdose surveillance system to improve timeliness of drug overdose monitoring. Methods We analyzed data on deaths in the King County (Washington) Medical Examiner’s Office (KCMEO) jurisdiction that occurred during March 1, 2017–February 28, 2018, and that had routine toxicology test results. Medical examiners (MEs) classified probable drug overdoses on the basis of information obtained through the death investigation and autopsy. We calculated sensitivity, positive predictive value, specificity, and negative predictive value of MEs’ classification by using the final death certificate as the gold standard. Results KCMEO investigated 2480 deaths; 1389 underwent routine toxicology testing, and 361 were toxicologically confirmed drug overdoses from opioid, stimulant, or euphoric drugs. Sensitivity of the probable overdose classification was 83%, positive predictive value was 89%, specificity was 96%, and negative predictive value was 94%. Probable overdoses were classified a median of 1 day after the event, whereas the final death certificate confirming an overdose was received by KCMEO an average of 63 days after the event. Conclusions King County MEs’ probable overdose classification provides a near–real-time indicator of fatal drug overdoses, which can guide rapid local public health responses to the drug overdose epidemic.

scholarly journals Role of annexin A2 and osteopontin for early diagnosis of hepatocellular carcinoma in hepatitis C virus patients

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Abd El-Fattah F. Hanno ◽  
Fatma M. Abd El-Aziz ◽  
Akram A. Deghady ◽  
Ehab H. El-Kholy ◽  
Aborawy I. Aborawy
Keyword(s):  
Hepatocellular Carcinoma ◽  
Chronic Hepatitis ◽  
Hepatitis C ◽  
Early Diagnosis ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Chronic Hepatitis C ◽  
Predictive Value ◽  
Annexin A2 ◽  
Alpha Fetoprotein

Abstract Background Liver cancer is the fifth most common cancer and the second most frequent cause of cancer-related death globally. Early stages of hepatocellular carcinoma (0&A) can be treated with curative procedures. The aim of this work was to evaluate the role of annexin A2 and osteopontin for early diagnosis of hepatocellular carcinoma in hepatitis C virus patients. Methods The study was carried out on 80 patients classified into two groups. Group A had 40 chronic hepatitis C patients without hepatocellular carcinoma, while group B had 40 chronic hepatitis C patients with early hepatocellular carcinoma (stages; 0&A). All patients were subjected to thorough history taking, clinical examination, liver function tests, renal function tests, serum alpha-fetoprotein, serum osteopontin, and serum annexin A2. Results Serum alpha-fetoprotein was found to be statistically significantly higher in patients with the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for alpha-fetoprotein for detection of HCC was significant, its diagnostic performance was 0.818* (p < 0.001*), and the cutoff point for predicting the probability for HCC was 6.0 (ng/ml) with sensitivity of 77.50%, specificity of 82.50%, positive predictive value of 81.60%, negative predictive value of 78.6%, and accuracy of 80%. Serum osteopontin was found to be statistically significantly higher in patients from the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for osteopontin was significant, its diagnostic performance was 0.739* (p < 0.001*), the cutoff point was 13.2 (ng/ml) with sensitivity of 65.0%, specificity of 90.0%, positive predictive value of 86.70%, negative predictive value of 72.0%, and accuracy of 77.0%. Serum annexin A2 was found to be statistically significantly higher in patients from the hepatocellular carcinoma group than the chronic hepatitis C group. The ROC curve for annexin A2 was significant, its diagnostic performance was 0.927* (p < 0.001*), the cutoff point was 10.1(ng/ml) with sensitivity of 85.0%, specificity of 85.0%, positive predictive value of 85.0%, negative predictive value of 85.0%, and accuracy of 85.0%. Conclusions Osteopontin had better specificity but lower sensitivity than serum alpha-fetoprotein for early diagnosis of hepatocellular carcinoma. Annexin A2 had better diagnostic sensitivity and specificity than alpha-fetoprotein for early diagnosis of hepatocellular carcinoma.

scholarly journals POS0706 PERFORMANCES OF DIFFERENT CLASSIFICATION CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS IN A SINGLE CENTER COHORT FROM TURKEY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 602.1-603
Author(s):  
E. S. Torun ◽  
E. Bektaş ◽  
F. Kemik ◽  
M. Bektaş ◽  
C. Cetin ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Antiphospholipid Syndrome ◽  
Lupus Erythematosus ◽  
Predictive Value ◽  
Sjogren's Syndrome ◽  
Classification Criteria ◽  
Systemic Lupus ◽  
Acr Criteria

Background:Recently developed EULAR/ACR classification criteria for systemic lupus erythematosus (SLE) have important differences compared to the 2012 Systemic Lupus International Collaborating Clinics (SLICC) SLE classification criteria and the revised 1997 American College of Rheumatology (ACR) criteria: The obligatory entry criterion of antinuclear antibody (ANA) positivity is introduced and a “weighted” approach is used1. Sensitivity and specificity of these three criteria have been debated and may vary in different populations and clinical settings.Objectives:We aim to compare the performances of three criteria sets/rules in a large cohort of patients and relevant diseased controls from a reference center with dedicated clinics for SLE and other autoimmune/inflammatory connective tissue diseases from Turkey.Methods:We reviewed the medical records of SLE patients and diseased controls for clinical and laboratory features relevant to all sets of criteria. Criteria sets/rules were analysed based on sensitivity, positive predictive value, specificity and negative predictive value, using clinical diagnosis with at least 6 months of follow-up as the gold standard. A subgroup analysis was performed in ANA positive patients for both SLE patients and diseased controls. SLE patients that did not fulfil 2012 SLICC criteria and 2019 EULAR/ACR criteria and diseased controls that fulfilled these criteria were evaluated.Results:A total of 392 SLE patients and 294 non-SLE diseased controls (48 undifferentiated connective tissue disease, 51 Sjögren’s syndrome, 43 idiopathic inflammatory myopathy, 50 systemic sclerosis, 52 primary antiphospholipid syndrome, 15 rheumatoid arthritis, 15 psoriatic arthritis and 20 ANCA associated vasculitis) were included into the study. Hundred and fourteen patients (16.6%) were ANA negative.Sensitivity was more than 90% for 2012 SLICC criteria and 2019 EULAR/ACR criteria and positive predictive value was more than 90% for all three criteria (Table 1). Specificity was the highest for 1997 ACR criteria. Negative predictive value was 76.9% for ACR criteria, 88.4% for SLICC criteria and 91.7% for EULAR/ACR criteria.In only ANA positive patients, sensitivity was 79.6% for 1997 ACR criteria, 92.2% for 2012 SLICC criteria and 96.1% for 2019 EULAR/ACR criteria. Specificity was 92.6% for ACR criteria, 87.8% for SLICC criteria 85.2% for EULAR/ACR criteria.Eleven clinically diagnosed SLE patients had insufficient number of items for both 2012 SLICC and 2019 EULAR/ACR criteria. Both criteria were fulfilled by 16 diseased controls: 9 with Sjögren’s syndrome, 5 with antiphospholipid syndrome, one with dermatomyositis and one with systemic sclerosis.Table 1.Sensitivity, positive predictive value, specificity and negative predictive value of 1997 ACR, 2012 SLICC and 2019 EULAR/ACR classification criteriaSLE (+)SLE (-)Sensitivity (%)Positive Predictive Value (%)Specificity (%)Negative Predictive Value (%)1997 ACR(+) 308(-) 841527978.695.494.976.92012 SLICC(+) 357(-) 352626891.193.291.288.42019 EULAR/ACR(+) 368(-) 242826693.892.990.591.7Conclusion:In this cohort, although all three criteria have sufficient specificity, sensitivity and negative predictive value of 1997 ACR criteria are the lowest. Overall, 2019 EULAR/ACR and 2012 SLICC criteria have a comparable performance, but if only ANA positive cases and controls are analysed, the specificity of both criteria decrease to less than 90%. Some SLE patients with a clinical diagnosis lacked sufficient number of criteria. Mostly, patients with Sjögren’s syndrome or antiphospholipid syndrome are prone to misclassification by both recent criteria.References:[1]Aringer M, Costenbader K, Daikh D, et al. 2019 European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus. Ann Rheum Dis 2019;78:1151-1159.Disclosure of Interests:None declared

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