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Performance of the Australian hospital-acquired complication algorithm for detecting hospital-onset bloodstream
Leon J Worth1, Stephanie J Curtis1, Rhonda L Stuart2
1Department of Infectious Diseases, The Alfred and School of Translational Medicine, Monash University, Melbourne, Australia.
Insights
The hospital-acquired complication (HAC) algorithm for detecting hospital-onset bloodstream infections (HO-BSIs) had a low positive predictive value (PPV). Removing unspecified sepsis codes significantly improved the PPV, enhancing diagnostic accuracy for HO-BSIs.
Area of Science:
- Healthcare quality and safety
- Infectious disease surveillance
- Health informatics
Background:
- The Australian Commission on Safety and Quality in Healthcare developed a list of 16 potentially preventable Hospital-Acquired Complications (HACs).
- An algorithm using International Classification of Disease (ICD) codes was created to detect these HACs.
- The performance of this algorithm for diagnosing hospital-onset bloodstream infections (HO-BSIs) required evaluation.
Purpose of the Study:
- To evaluate the performance of the BSI HAC algorithm in identifying hospital-onset bloodstream infections (HO-BSIs).
- To assess the positive predictive value (PPV) and negative predictive value (NPV) of the algorithm.
- To explore modifications to the algorithm to improve its diagnostic accuracy.
Main Methods:
- Extracted administrative records for admitted patient care from five Australian hospitals (July 2016 - June 2017).
- Applied the BSI HAC algorithm to identify potential HO-BSIs.
- Randomly selected and reviewed episodes by blinded reviewers using a reference surveillance definition.
- Calculated PPV and NPV, and tested algorithm modifications.
Main Results:
- The BSI HAC algorithm demonstrated a low PPV of 0.28 (95% CI, 0.23-0.34) and a high NPV of 1.00 (95% CI, 0.98-1.00).
- 'Sepsis, unspecified' and 'bacterial sepsis of newborn, unspecified' codes were frequent triggers but had very low PPVs (0.06 and 0.03).
- Removing these unspecified sepsis codes increased the algorithm's PPV to 0.53 (95% CI, 0.45-0.62).
Conclusions:
- The existing HAC algorithm exhibits sub-optimal performance for accurately identifying hospital-onset bloodstream infections.
- The inclusion of 'unspecified sepsis' ICD codes significantly contributes to the algorithm's low positive predictive value.
- Modifying the algorithm by removing these codes substantially improves its accuracy in detecting HO-BSIs.
Background:
The Australian Commission on Safety and Quality in Healthcare developed a list of sixteen potentially preventable Hospital-Acquired Complications (HACs) and an algorithm using International Classification of Disease (ICD) codes to detect them. We evaluated this algorithm's performance for diagnosing hospital-onset bloodstream infections (HO-BSI).
Methods:
Administrative records were extracted for episodes of admitted patient care from July 2016 to June 2017 at five Australian principal referral hospitals. We applied the BSI HAC algorithm to each episode, then randomly selected 50 patients deemed positive and negative for HO-BSI at each site. Reviewers blinded to HAC status applied the reference surveillance definition for HO-BSI. The positive predictive value (PPV) and negative predictive value (NPV) for the BSI HAC were calculated. We explored changes to the HAC algorithm to improve these metrics.
Results:
Overall, 352 917 episodes were included; median (IQR) age was 54 (33-71) years, 49.6 % were female, and 43.8 % were elective admissions. Of these, 2229 (0.6 %) had a HO-BSI according to the HAC algorithm. Among manually reviewed episodes, the PPV for the HAC algorithm was 0.28 (95 % CI, 0.23-0.34) and the NPV was 1.00 (95 % CI, 0.98-1.00). The codes 'Sepsis, unspecified' and 'bacterial sepsis of newborn, unspecified' were both common triggers for HO-BSI HACs (accounting for 35.8 % and 18.4 % of HO-BSIs, respectively) and had poor PPV (0.06 and 0.03, respectively). Removal of these codes from the algorithm increased PPV to 0.53 (0.45-0.62).
Conclusion:
The HAC algorithm had sub-optimal PPV for HO-BSI. This performance was improved by removing the 'unspecified sepsis' ICD codes.
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