2151. Accuracy of Physician Adjudication of Infection in Patients with Systemic Inflammatory Response Syndrome (SIRS)
Session: Poster Abstract Session: Healthcare Epidemiology: Epidemiologic Methods
Saturday, October 6, 2018
Room: S Poster Hall
Posters
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  • Background: The definition of sepsis evolves with improved understanding of the pathophysiology, but the presence of infection remains essential for the diagnosis. Despite this fact, there are currently no universal objective definitions for infections, which increases the variability in sepsis diagnoses. This variation makes interpretation of diagnostic studies, therapeutic interventions, and prognostic tools challenging. In this study, we compared physician adjudication of infection to standardized definitions of infection in patients meeting 2 of 4 Systemic Inflammatory Response Syndrome (SIRS) criteria.

    Methods: In a prospective observational study performed in 2 academic medical centers, patients with 2 of 4 SIRS criteria were enrolled in Emergency Departments from February 2016 to December 2016. Diagnostic and physiologic data were abstracted for 151 patients at admission. Each medical record was independently reviewed by 1 Emergency Medicine and 1 Critical Care (CC) physician from a 10-member adjudicating committee to determine the presence of infection. In the case of disagreement, a third CC physician served as the tiebreaker.  Objective definitions of infection were derived from consensus surveillance definitions.  

    Results: Overall, both adjudicators and the objective definitions agreed on the presence of infection 93% of the time and on the absence of infection 82.7% of the time. Of the patients adjudicated as indeterminate or not infected, 8 and 13 met one objective definition of infection, respectively. The greatest discordance between physician adjudicated infection and objective definitions occurred in pneumonia patients (Table 1).    

    Physician Adjudication

    Objective Definition of infection

    Infected

    Indeterminate

    Not Infected

    Not Infected

    4

    11

    62

    Infected (Pneumonia)

    53

    8 (5)

    13 (4)

    Total

    57

    19

    75

    Conclusion: Implicit to the definition of sepsis is the presence of infection. Therefore, standardized methods of defining infections are necessary to decrease the variability in diagnoses and allow comparability among clinical trials. The application of objective definitions could prove to be a reproducible and reliable foundation for use by clinical investigators.

    Morgan Walker, M.D., Internal Medicine, LSU Health Baton Rouge, Baton Rouge, LA, Diana Hamer, PhD, Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, Mandi Musso, PhD, Our Lady of the Lake, Baton Rouge, LA, Catherine O'Neal, MD, Infectious Diseases, Lousiana State University Health Sciences Center, Baton Rouge, LA, Christopher Thomas, MD, Pulmonary and Critical Care Medicine, LSUHSC Baton Rouge Internal Medicine, Baton Rouge, LA and Hollis O'Neal Jr., M.D., M.Sc., Pulmonary and Critical Care Medicine, Louisiana State University Health Sciences Center, Baton Rouge, LA

    Disclosures:

    M. Walker, None

    D. Hamer, None

    M. Musso, None

    C. O'Neal, None

    C. Thomas, None

    H. O'Neal Jr., None

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