acquired, 71 (24%) had CDI with 11% (8/71) ICU‐acquired, and 20 (7%) had SSI with nine of 20 ICU‐acquired. In 63 (22%) of all cases more than one of the evaluated HAI were present, with pneumonia and BSI most frequently selected for review (26/63 each). Assigned scores With 3CAT, the HAI was considered to have definitely or possibly contributed to the patient’s death in 83% of cases according to the TP and 87% according to the OSI (Table 2). For the types of HAI, the responses of TP and OSI were respectively 71% and 81% for pneumonia, 94% and 95% for BSI and 82% and 85% for CDI (Supplementary Table S1). When the contribution was considered definite, it was viewed as a major contribution in, respectively, 92 (118/128) and 96% (108/113), whereas when the contribution was considered possible, it was viewed as major contribution in 30% (34/112 and 42/140) for both TP and OSI. With WHOCAT, the HAI was considered part of the causal sequence in the majority of patients (56 % for TP and 55% for OSI) and rarely viewed as the sole cause (9% and 7%, respectively). Table 2 summarises the ratings for 3CAT and WHOCAT and Figure 1 summarises the ratings for QUANT. The measures corresponded reasonably well with each other, with Pearson correlation coefficients in the range of 0.83 (95% confidence interval (CI): 0.79‐0.86) to 0.72 (95% CI: 0.65‐0.77). Correlation was highest between 3CAT and QUANT and lowest between 3CAT and WHOCAT (Figure 2), independent of whether the TP or OSI performed the review. Because of the correlation some of the results will therefore be presented for 3CAT only. Inter‐rater reliability and perceived fit The wk for 3CAT was 0.68 overall, whereas the percentage of initial agreement was 76% (Table 3). Consensus agreement after discussion was reached in 93% of cases. Percentage agreement was the highest when the contribution of the HAI was considered definitely present (> 80%, except for CDI) and lowest for the category ‘did not contribute’. The wk differed between hospitals, ranging from 0.26 to 1.00 (wk) (p=0.015) and was higher in tertiary then in secondary care centres (p=0.03 for pneumonia, p=0.07 for BSI). The kappa on whether the HAI was a major or minor cause, when 3CAT assessments were ‘possibly contributed’ or ‘definitely contributed’, was 0.69 (95% CI: 0.60‐0.79) and agreement was 86% (197/229). The order of the categories of WHOCAT was less clear‐cut than that of 3CAT and QUANT. In all except two hospitals, the inter‐rater reliability was the same or higher when assuming that the categories of the variable were ordered than when the categories were considered not ordered. The inter‐rater reliability for WHOCAT was comparable to 112 Chapter 6
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