Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients
Surgical wound infection as a performance indicator: agreement of common definitions of wound infection in 4773 patients
复制标题
DOI：
10.1136/bmj.38232.646227.de
复制
发表时间：
2004-09-25
影响因子：
--
通讯作者：
Pearson, A
中科院分区：
文献类型：
--
作者：
Wilson, APR;Gibbons, C;Pearson, A
目的评价常用的伤口感染定义之间的一致程度，可作为临床表现指标。设计前瞻性观察性研究。设置伦敦教学医院集团接收急诊病例以及三级转诊。参与者4773名住院至少两晚的外科患者。主要观察指标：仅以脓性分泌物、疾病控制中心（CDC）对伤口感染的定义、CDC定义的医院感染国家监测计划（NINSS）版本以及ASEPSIS评分方法为基础的伤口感染数量。结果5028例住院患者共评估5804例外科伤口。不同定义的伤口感染平均百分比差异很大：CDC定义为19.2%(95%置信区间为18.1%至20.4%)，NINSS定义为14.6%(13.6%至15.6%)，单独脓液定义为12.3%(11.4%至13.2%)，ASEPSIS评分为bb20的伤口为6.8%（6.1%至7.5%）。关于个别伤口的定义之间的一致性很差。有脓的伤口被CDC、NINSS和单独脓的定义自动定义为感染，但只有39%（283/714）的伤口有ASEPSIS评分bb20。结论：对CDC定义甚至解释的微小改变，如NINSS版本，会导致伤口感染估计百分比的重大变化。大量伤口根据感染程度进行了不同的分类。一致使用的单一定义可以显示单个中心伤口感染百分比随时间的变化，但解释的差异阻碍了不同中心之间的比较。
Objective To assess the level of agreement between common definitions of wound infection that might be used as performance indicators.Design Prospective observational study.Setting London teaching hospital group receiving emergency cases as well as tertiary referrals.Participants 4773 surgical patients staying in hospital at least two nights.Main outcome measures Numbers of wound infections based on purulent discharge alone, on the Centers for Disease Control (CDC) definition of wound infection, on the nosocomial infection national surveillance scheme (NINSS) version of the CDC definition, and on the ASEPSIS scoring method.Results 5804 surgical wounds were assessed during 5028 separate hospital admissions. The mean percentage of wounds classified as infected differed substantially with different definitions: 19.2% with the CDC definition (95% confidence interval 18.1% to 20.4%), 14.6% (13.6% to 15.6%) with the NINSS version, 12.3% (11.4% to 13.2%) with pus alone, and 6.8% (6.1% to 7.5%) with an ASEPSIS score >20. The agreement between definitions with respect to individual wounds was poor. Wounds with pus were automatically defined as infected with the CDC, NINSS, and pus alone definitions, but only 39% (283/714) of these had ASEPSIS scores >20.Conclusions Small changes made to the CDC definition or even in its interpretation, as with the NINSS version, caused major variation in estimated percentage of wound infection. Substantial numbers of wounds were differently classified across the grades of infection. A single definition used consistently can show changes in percentage wound infection over time at a single centre, but differences in interpretation prevent comparison between different centres.