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Multicenter Study
. 2021 Jun;26(23):2000052.
doi: 10.2807/1560-7917.ES.2021.26.23.2000052.

Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018

Tjallie van der Kooi  1 , Alain Lepape  2   3 , Pascal Astagneau  2   4 , Carl Suetens  5 , Mioara Alina Nicolaie  1 , Sabine de Greeff  1 , Ilma Lozoraitiene  6 , Jacek Czepiel  7 , Márta Patyi  8 , Diamantis Plachouras  5 ; HAI-Net Mortality review study group  9 ; Members of the HAI-Net Mortality review study group
Collaborators, Affiliations
Multicenter Study

Mortality review as a tool to assess the contribution of healthcare-associated infections to death: results of a multicentre validity and reproducibility study, 11 European Union countries, 2017 to 2018

Tjallie van der Kooi et al. Euro Surveill. 2021 Jun.

Abstract

IntroductionThe contribution of healthcare-associated infections (HAI) to mortality can be estimated using statistical methods, but mortality review (MR) is better suited for routine use in clinical settings. The European Centre for Disease Prevention and Control recently introduced MR into its HAI surveillance.AimWe evaluate validity and reproducibility of three MR measures.MethodsThe on-site investigator, usually an infection prevention and control doctor, and the clinician in charge of the patient independently reviewed records of deceased patients with bloodstream infection (BSI), pneumonia, Clostridioides difficile infection (CDI) or surgical site infection (SSI), and assessed the contribution to death using 3CAT: definitely/possibly/no contribution to death; WHOCAT: sole cause/part of causal sequence but not sufficient on its own/contributory cause but unrelated to condition causing death/no contribution, based on the World Health Organization's death certificate; QUANT: Likert scale: 0 (no contribution) to 10 (definitely cause of death). Inter-rater reliability was assessed with weighted kappa (wk) and intra-cluster correlation coefficient (ICC). Reviewers rated the fit of the measures.ResultsFrom 2017 to 2018, 24 hospitals (11 countries) recorded 291 cases: 87 BSI, 113 pneumonia , 71 CDI and 20 SSI. The inter-rater reliability was: 3CAT wk 0.68 (95% confidence interval (CI): 0.61-0.75); WHOCAT wk 0.65 (95% CI: 0.58-0.73); QUANT ICC 0.76 (95% CI: 0.71-0.81). Inter-rater reliability ranged from 0.72 for pneumonia to 0.52 for CDI. All three measures fitted 'reasonably' or 'well' in > 88%.ConclusionFeasibility, validity and reproducibility of these MR measures was acceptable for use in HAI surveillance.

Keywords: Clostridioides difficile; bloodstream infection; healthcare-associated infection; inter-rater reliability; mortality; pneumonia.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Agreement for ratings for the quantitative scale, mortality review of the contribution of healthcare-associated infections to death, 11 EU countries, April 2017–February 2018 (n = 289)
Figure 2
Figure 2
Correspondence between different outcome measures, assessment by the treating physician, mortality review of the contribution of healthcare-associated infections to death, 11 EU countries, April 2017–February 2018
See this image and copyright information in PMC

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