• Prehosp Emerg Care · Oct 2014

    Comparative Study

    A Comparative Assessment of Adverse Event Classification in the Out-of-hospital Setting.

    • P Daniel Patterson, Judith R Lave, Matthew D Weaver, Francis X Guyette, Robert M Arnold, Christian Martin-Gill, Jon C Rittenberger, David Krackhardt, Vincent N Mosesso, Ronald N Roth, Richard J Wadas, and Donald M Yealy.
    • Prehosp Emerg Care. 2014 Oct 1; 18 (4): 495-504.

    ObjectivesWe sought to test reliability of two approaches to classify adverse events (AEs) associated with helicopter EMS (HEMS) transport.MethodsThe first approach for AE classification involved flight nurses and paramedics (RN/Medics) and mid-career emergency physicians (MC-EMPs) independently reviewing 50 randomly selected HEMS medical records. The second approach involved RN/Medics and MC-EMPs meeting as a group to openly discuss 20 additional medical records and reach consensus-based AE decision. We compared all AE decisions to a reference criterion based on the decision of three senior emergency physicians (Sr-EMPs). We designed a study to detect an improvement in agreement (reliability) from fair (kappa = 0.2) to moderate (kappa = 0.5). We calculated sensitivity, specificity, percent agreement, and positive and negative predictive values (PPV/NPV).ResultsFor the independent reviews, the Sr-EMP group identified 26 AEs while individual clinician reviewers identified between 19 and 50 AEs. Agreement on the presence/absence of an AE between Sr-EMPs and three MC-EMPs ranged from κ = 0.20 to κ = 0.25. Agreement between Sr-EMPs and three RN/Medics ranged from κ = 0.11 to κ = 0.19. For the consensus/open-discussion approach, the Sr-EMPs identified 13 AEs, the MC-EMP group identified 18 AEs, and RN/medic group identified 36 AEs. Agreement between Sr-EMPs and MC-EMP group was (κ = 0.30 95%CI -0.12, 0.72), whereas agreement between Sr-EMPs and RN/medic group was (κ = 0.40 95%CI 0.01, 0.79). Agreement between all three groups was fair (κ = 0.33, 95%CI 0.06, 0.66). Percent agreement (58-68%) and NPV (63-76%) was moderately dissimilar between clinicians, while sensitivity (25-80%), specificity (43-97%), and PPV (48-83%) varied.ConclusionsWe identified a higher level of agreement/reliability in AE decisions utilizing a consensus-based approach for review rather than independent reviews.

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