Related Experiment Video
Updated: Mar 23, 2026
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Measuring Surgical Site Infections in Children: Comparing Clinical, Electronic, and Administrative Data
Afif N Kulaylat1, Brett W Engbrecht1, Dorothy V Rocourt1
1Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA.
Insights
Comparing methods for identifying surgical site infections (SSIs) in children, this study found poor correlation between electronic surveillance, claims data, and clinical registries. Clinically derived data like NSQIP Pediatric offers a more accurate quality metric for pediatric SSIs.
Area of Science:
- Pediatric Surgery
- Healthcare Quality Improvement
- Infectious Disease Surveillance
Background:
- Surgical site infections (SSIs) are critical indicators of healthcare quality.
- Accurate measurement of SSIs is essential for quality assessment and cost estimation.
- Multiple methods exist for SSI identification, including clinical registries, electronic surveillance, and administrative claims data.
Purpose of the Study:
- To compare the accuracy of different methods for measuring SSIs in pediatric surgical patients.
- To evaluate the implications of these measurement differences on healthcare cost estimations.
- To determine the most appropriate method for assessing the burden of SSIs in children.
Main Methods:
- A retrospective study of 5,476 pediatric surgical patients from January 1, 2010, to August 31, 2014.
- SSIs were identified using the NSQIP Pediatric clinical registry, an electronic surveillance system (Nosocomial Infection Marker), and billing claims.
- Infection rates, diagnostic characteristics (sensitivity, positive predictive value), and attributable costs were compared across the three methods.
Main Results:
- SSI detection rates varied significantly: 2.24% (NSQIP Pediatric), 0.99% (Nosocomial Infection Marker), and 2.34% (billing claims).
- The Nosocomial Infection Marker showed low sensitivity (31.7%) and billing claims showed low positive predictive value (46.1%) compared to NSQIP Pediatric.
- Electronic surveillance and billing claims overestimated SSI costs by 108% and 41%, respectively.
Conclusions:
- There is a poor correlation between SSIs identified by electronic surveillance, administrative claims, and clinical registries in pediatric surgery.
- Clinically derived data, such as NSQIP Pediatric, are more appropriate for quality metrics and estimating the postoperative burden of SSIs in children.
- Convenience of electronic or claims data may lead to inaccurate quality assessments and cost estimations for pediatric SSIs.
Background:
Surgical site infections (SSIs) are an important end point and measure of quality of care. Surgical site infections can be identified using clinical registries, electronic surveillance, and administrative claims data. This study compared measurements of SSIs using these 3 different methods and estimated their implication for health care costs.
Study Design:
Data were obtained from 5,476 surgical patients treated at a single academic children's hospital (January 1, 2010 through August 31, 2014). Surgical site infections within 30 days were identified using a clinical registry in the NSQIP Pediatric, an electronic surveillance method (Nosocomial Infection Marker; MedMined), and billing claims. Infection rates, diagnostic characteristics, and attributable costs were estimated for each of the 3 measures of SSI.
Results:
Surgical site infections were observed in 2.24% of patients per NSQIP Pediatric definitions, 0.99% of patients per the Nosocomial Infection Marker, and 2.34% per billing claims definitions. Using NSQIP Pediatric as the clinical reference, Nosocomial Infection Marker had a sensitivity of 31.7% and positive predictive value of 72.2%, and billing claims had a sensitivity of 48.0% and positive predictive value of 46.1% for detection of an SSI. Nosocomial Infection Marker and billing claims overestimated the costs of SSIs by 108% and 41%, respectively.
Conclusions:
There is poor correlation among SSIs measured using electronic surveillance, administrative claims, and clinically derived measures of SSI in the pediatric surgical population. Although these measures might be more convenient, clinically derived data, such as NSQIP Pediatric, may provide a more appropriate quality metric to estimate the postoperative burden of SSIs in children.
Related Concept Videos
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:30Methods of Documentation VII: EMR
01:14Temperature Measurement Sites
Oral: When assessing oral temperature, the thermometer tip should be placed under the tongue in the posterior sublingual pocket. It offers accurate readings and can be...
01:24Automated Microbial Diagnostics
01:27Nursing Clinical Information System
A Nursing Clinical Information System (NCIS) is a specialized type of healthcare information system tailored to meet the unique needs of nursing practice. It incorporates the principles of nursing informatics to streamline information management and improve the quality of care delivery.
Critical attributes of NCIS include: