Interobserver Agreement for Classifying Infections in Emergency Department Patients Using Modified Centers for...

Area of Science:

• Emergency Medicine
• Infectious Diseases
• Clinical Epidemiology

Background:

• Standardized classification of infections and sepsis in emergency departments (EDs) is crucial for accurate diagnosis and treatment.
• Existing methods may lack reproducibility in heterogeneous ED populations.

Purpose of the Study:

• To develop and evaluate a standardized ED-adapted framework for reproducible infection and sepsis classification.
• The framework is based on Centers for Disease Control (CDC) surveillance definitions and a modified Sequential Organ Failure Assessment (SOFA) score.

Main Methods:

• A prospective cohort study (BIOSEP) enrolled adults with suspected infection and a Modified Early Warning Score ≥2 in 4 Dutch hospitals.
• Patients' electronic health records were retrospectively adjudicated by blinded physicians for infection plausibility, diagnosis, pathogen, and sepsis occurrence.
• Interobserver agreement was quantified using Cohen's kappa and Gwet's agreement coefficients.

Main Results:

• 1062 ED patients and 1145 infection episodes were analyzed.
• High interobserver agreement was found for infection diagnosis (κ=0.87), causative pathogens (κ=0.89), and sepsis occurrence (κ=0.80).
• Agreement for infection plausibility was also high (weighted κ=0.87).

Conclusions:

• The developed ED-adapted framework demonstrates high interobserver agreement for infection and sepsis classification.
• This standardized approach is suitable for large-scale observational research in diverse ED populations.
• The framework enhances the reliability of infection and sepsis classification in emergency care settings.