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Bleeding assessment following central venous catheter placement, a direct comparison of prospective and retrospective
Floor L F van Baarle1,2, Emma K van de Weerdt1,2, S Jorinde Raasveld1,2
1Department of Intensive Care Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.
Insights
Retrospective chart review and photographic assessment significantly underreport bleeding after central venous catheter placement compared to prospective methods. This bias impacts the accuracy of bleeding complication data in medical studies.
Area of Science:
- Medical research methodology
- Clinical trial analysis
- Patient safety and outcomes
Background:
- Bleeding complication rates after central venous catheter (CVC) placement vary significantly based on assessment methods.
- Retrospective data collection may introduce bias in reporting CVC-related bleeding incidences.
Purpose of the Study:
- To compare the accuracy of bleeding severity assessment methods for central venous catheters.
- To quantify the bias introduced by retrospective chart review and photographic assessment versus prospective clinical assessment.
Main Methods:
- A patient-level comparison of bleeding severity was conducted using prospective data, photographic assessment, and retrospective chart review.
- Interrater reliability was assessed using Cohen's kappa, and underreporting was evaluated using McNemar's test.
Main Results:
- Both photographic assessment and retrospective chart review demonstrated acceptable interrater reliability.
- Photographic assessment significantly underreported bleeding complications across all severity levels.
- Retrospective chart review significantly underreported minor bleeding complications (OR 0.17) but not major ones.
Conclusions:
- Centralized photographic bleeding assessment and retrospective chart review introduce significant bias compared to prospective clinical assessment.
- These findings highlight the limitations of retrospective methods in accurately capturing CVC-related bleeding events.
Background:
Reported bleeding incidences following central venous catheter (CVC) placement highly depend on methods of bleeding assessment. To determine the direction and magnitude of the bias associated with retrospective data collection, we used data from the PACER randomized controlled trial and a previous retrospective cohort study.
Study Design And Methods:
A patient-level comparison of CVC-related bleeding severity was made among (1) the prospectively collected clinical bleeding assessment of the PACER trial, (2) centralized assessment of CVC insertion site photographs, and (3) retrospective chart review. Interrater reliability for photographic bleeding assessment and retrospective chart review was assessed using Cohen's κ. The magnitude of underreporting of both methods compared to prospective clinical bleeding assessment at different cutoff points of clinically relevant bleeding was assessed using McNemar's test.
Results:
Interrater reliability was acceptable for both methods (κ = 0.583 and κ = 0.481 for photographic assessment and retrospective chart review, respectively). Photographic bleeding assessment led to significant underreporting of bleeding complications at all cutoff points. Retrospective chart review led to significant underreporting of minor bleeding complications, with an odds ratio (95% CI) of 0.17 (0.044-0.51) for the cutoff point grade 1 (i.e., self-limiting or requiring at most 20 min of manual compression) or higher. There was no significant underreporting of major bleeding complications with retrospective chart review.
Discussion:
Centralized photographic bleeding assessment and retrospective chart review lead to biased bleeding assessment compared to prospective clinical bleeding assessment.
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