Patient and healthcare‐associated infection characteristics associated with agreement and contribution to death Both the agreement on the initial assessments (Supplementary Table S4) and the consensus were higher for the patient and HAI characteristics that were to be assessed separately, than for the contribution of HAI to death. The agreement ranged from 81% (234/290) for the presence of pathophysiological mechanism to 95% (275/291) for whether the HAI or a complication of the HAI was active at the time of death. Agreement on the contribution to death was strongly correlated with the number of patient and HAI characteristics for which there was agreement between the TP and the OSI (Pearson correlation coefficient 0.98, 95% CI: 0.70‐1.00). Agreement was associated with disease severity; it was better for the two extremes severity statuses (not or mildly ill: 43/52 and severely ill: 87/104) than for intermediate severity (68%; 91/134). The presence of a pathophysiological mechanism for the contribution of HAI to death was most strongly associated with a contribution considered definite, for all three measures (Supplementary Table S5). Severity of HAI and presence of a competing cause for death were among the top three associated factors. The type of HAI, whether the HAI or complication of the HAI was active on the day of death, ICU admission and the Charlson’s severity score were, to a lesser extent, also associated with contribution to death. HAI were considered to contribute more to the death of ‘moderately ill’ patients (‘definitely’ contributed in 51% for TP and 44% for OSI) than in ‘not or mildly ill’ patients (38% for TP and 38% for OSI) or ‘severely ill’ patients (38% for TP and 33% for OSI) (Supplementary Table S7). DISCUSSION Our study demonstrated that the inter‐rater reliability of three mortality review measures for the contribution of HAI to death, measured with wk and percentage agreement, was moderate to strong, depending on the type of HAI. Together with the correlation between the three outcomes, 3CAT, WHOCAT and QUANT, and the perceived fit, corroborating the validity, this implies that the mortality review measures are considered acceptable for use in HAI surveillance. Although feasibility was not evaluated in detail MR appeared feasible in the participating centres. Meeting up with the treating physicians was sometimes challenging but this could improve when MR is embedded in standard practice. 118 Chapter 6
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