Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.
Multicenter evaluation of computer automated versus traditional surveillance of hospital-acquired bloodstream infections.
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DOI：
10.1086/678602
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发表时间：
2014-12
影响因子：
4.5
通讯作者：
Centers for Disease Control and Prevention Epicenter Program
中科院分区：
文献类型：
--
作者：
Lin MY;Woeltje KF;Khan YM;Hota B;Doherty JA;Borlawsky TB;Stevenson KB;Fridkin SK;Weinstein RA;Trick WE;Centers for Disease Control and Prevention Epicenter Program
中心静脉导管相关血流感染 (BSI) 率是比较医院质量和安全性的关键质量指标。传统的 BSI 监测可能会受到受试者间变异性的限制。我们评估了中心线相关 BSI 检测的计算机自动化方法是否可以提高监测的有效性。回顾性队列研究。 4 个学术医疗中心设有 8 个医疗和外科重症监护病房 (ICU)。将传统监测（由医院工作人员进行）和计算机算法监测与使用 2004 年至 2007 年期间回收生物体的血培养事件的随机样本进行的回顾性审计审查进行比较。使用 κ 统计量来衡量情节级别与审计审查的一致性，并使用相等 κ 系数检验来评估差异。使用线性回归评估监测性能 (κ) 与监测报告的 BSI 率（每 1,000 个中心线天的 BSI）之间的关系。我们评估了 664 次血培养。传统监测 (κ [95% 置信区间 (CI)] = 0.44 [0.37–0.51]) 与审计审查的一致性显着低于计算机算法监测 (κ [95% CI] = 0.58 [0.52–0.64]；P = 0.001)。传统监测和审计审查之间的一致性在各个 ICU 中存在差异 (P = .01)；此外，传统监测在报告 BSI 率较低（较好）的 ICU 中表现较差 (P = .001)。相比之下，各个 ICU 以及计算机报告的中心线相关 BSI 率范围内的计算机算法性能是一致的。与传统的血流感染监测相比，计算机自动监测提高了准确性和可靠性，使设施间性能比较更加有效。
Central line–associated bloodstream infection (BSI) rates are a key quality metric for comparing hospital quality and safety. Traditional BSI surveillance may be limited by interrater variability. We assessed whether a computer-automated method of central line–associated BSI detection can improve the validity of surveillance. Retrospective cohort study. Eight medical and surgical intensive care units (ICUs) in 4 academic medical centers. Traditional surveillance (by hospital staff) and computer algorithm surveillance were each compared against a retrospective audit review using a random sample of blood culture episodes during the period 2004–2007 from which an organism was recovered. Episode-level agreement with audit review was measured with κ statistics, and differences were assessed using the test of equal κ coefficients. Linear regression was used to assess the relationship between surveillance performance (κ) and surveillance-reported BSI rates (BSIs per 1,000 central line–days). We evaluated 664 blood culture episodes. Agreement with audit review was significantly lower for traditional surveillance (κ [95% confidence interval (CI)] = 0.44 [0.37–0.51]) than computer algorithm surveillance (κ [95% CI] = 0.58 [0.52–0.64]; P = .001). Agreement between traditional surveillance and audit review was heterogeneous across ICUs (P = .01); furthermore, traditional surveillance performed worse among ICUs reporting lower (better) BSI rates (P = .001). In contrast, computer algorithm performance was consistent across ICUs and across the range of computer-reported central line–associated BSI rates. Compared with traditional surveillance of bloodstream infections, computer automated surveillance improves accuracy and reliability, making interfacility performance comparisons more valid.
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影响因子：
4.5
作者：
McBryde, Emma S.;Brett, Judy;Richards, Michael J.
通讯作者：
Richards, Michael J.
影响因子：
4.9
作者：
Wright, Marc-Oliver;Fisher, Adrienne;Robicsek, Ari
通讯作者：
Robicsek, Ari
DOI：
10.1197/jamia.m3196
发表时间：
2010-01-01
影响因子：
6.4
作者：
Hota, Bala;Lin, Michael;Trick, William
通讯作者：
Trick, William
影响因子：
11.8
作者：
Fraser, Thomas G.;Gordon, Steven M.
通讯作者：
Gordon, Steven M.
影响因子：
4.5
作者：
Woeltje, Keith F.;McMullen, Kathleen M.;Doherty, Joshua A.
通讯作者：
Doherty, Joshua A.