• Catherine S O'Neal, Diana Hamer, Mandi W Musso, Terrell S Caffery, Morgan K Walker, Katherine W Lavie, Matthew S Berlinger, Christopher B Thomas, Shannon M Alwood, Tonya Jagneaux, Michael A Sanchez, and Hollis R O'Neal.
• Louisiana State University Health Sciences Center, Internal Medicine Residency Program, Baton Rouge, LA, USA; Our Lady of the Lake Regional Medical Center, Baton Rouge, LA, USA. Electronic address: coneal@lsuhsc.edu.
• Am. J. Med. Sci. 2022 Aug 1; 364 (2): 163-167.

BackgroundThis study examined three methods for retrospectively identifying infection in emergency department (ED) patients: modified objective definitions of infection (MODI) from the CDC/NHSN, physician adjudication determination of infection, and ED treating physician behavior.MethodsThis study used a subset of data from a prospective sepsis trial. We used Fleiss's Kappa to compare agreement between two physicians retrospectively adjudicating infection based on the patient's medical record, modified infection definition from the CDC/NHSN, and ED treating physician behavior.ResultsOverall, there was similar agreement between physician adjudication of infection and MODI criteria (Kappa=0.59) compared to having two physicians independently identify infection through retrospective chart review (Kappa=0.58). ED treating physician behavior was a poorer proxy for infection when compared to the MODI criteria (0.41) and physician adjudication (Kappa = 0.50).ConclusionsRetrospective identification of infection poses a significant challenge in sepsis clinical trials. Using modified definitions of infection provides a standardized, less time consuming, and equally effective means of identifying infection compared to having multiple physicians adjudicate a patient's chart.Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

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