在体外膜氧化过程中对感染进行分类的研究人员之间的协议
Karlijn Verkerk1, Lara Ca Pladet1, Christiaan L Meuwese2,3
1Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
The International journal of artificial organs
|August 19, 2023
概括
在体外膜氧化 (ECMO) 期间发生的传染病例显示,评级者之间关于发生的意见不一致,但在感染地点上有很好的共识. 这种变化可能解释了ECMO中心报告的不同感染率.
科学领域:
- 关键护理医学 关键护理医学
- 传染性疾病 传染性疾病
- 改善医疗质量 改善医疗质量
背景情况:
- 感染性并发症在体外膜氧化 (ECMO) 期间很常见,影响患者的治疗结果.
- 报告的感染发病率的变化阻碍了使用感染作为ECMO中心的质量基准.
研究的目的:
- 评估评估者间协议对在重症监护室 (ICU) 接受ECMO的患者感染发作评估的影响.
- 为了确定是否在识别感染发生或部位方面达成不良协议,导致ECMO相关感染率报告中的差异.
主要方法:
- 三位独立评估人员审查了接受ECMO治疗超过24小时的ICU患者的病历,以确定和确定疑似传染病发作的日期.
- 感染识别,发病和部位的差异由专家小组组成的专家小组和传染病专家解决.
- 使用弗莱斯的Kappa统计和一致率量化了Interrater协议.
主要成果:
- 在77名患者的83次ECMO运行中,共判定了62次传染性发作 (发病率:62每1000个患者危险日).
- 只有54%的疑似传染病发作被所有三个评级者确定 (Fleiss' kappa = 0.10,表明轻微的同意).
- 当评级者同意感染发病时,感染地点的一致性很高 (89%的一致性,kappa = 0.85,几乎是完美的一致性).
结论:
- 在ECMO期间对传染病发作进行判断的特点是关于感染发生的差异性协议,但关于感染地点的良好协议.
- 这种关于感染发生的缺乏共识可能部分解释了ECMO中心报告的感染率的巨大差异.
- 在解释ECMO种群中的感染数据时,建议谨慎使用,因为可能存在因虫间变异性引起的测量错误.
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