Physician agreement on the diagnosis of sepsis in the intensive care unit: estimation of concordance and analysis of underlying factors in a multicenter cohort.
Diagnosis
Intensive care
Inter-observer agreement
Sepsis
Journal
Journal of intensive care
ISSN: 2052-0492
Titre abrégé: J Intensive Care
Pays: England
ID NLM: 101627304
Informations de publication
Date de publication:
2019
2019
Historique:
received:
07
12
2018
accepted:
28
01
2019
entrez:
5
3
2019
pubmed:
5
3
2019
medline:
5
3
2019
Statut:
epublish
Résumé
Differentiating sepsis from the systemic inflammatory response syndrome (SIRS) in critical care patients is challenging, especially before serious organ damage is evident, and with variable clinical presentations of patients and variable training and experience of attending physicians. Our objective was to describe and quantify physician agreement in diagnosing SIRS or sepsis in critical care patients as a function of available clinical information, infection site, and hospital setting. We conducted a post hoc analysis of previously collected data from a prospective, observational trial ( Free-marginal kappa decreased between the initial impression of the attending physician and (1) the initial impression of the site investigator ( Considerable uncertainty surrounds the differential clinical diagnosis of sepsis vs. SIRS, especially before organ damage has become highly evident, and for patients presenting with respiratory clinical signs. Our findings underscore the need to provide physicians with accurate, timely diagnostic information in evaluating possible sepsis.
Sections du résumé
BACKGROUND
BACKGROUND
Differentiating sepsis from the systemic inflammatory response syndrome (SIRS) in critical care patients is challenging, especially before serious organ damage is evident, and with variable clinical presentations of patients and variable training and experience of attending physicians. Our objective was to describe and quantify physician agreement in diagnosing SIRS or sepsis in critical care patients as a function of available clinical information, infection site, and hospital setting.
METHODS
METHODS
We conducted a post hoc analysis of previously collected data from a prospective, observational trial (
RESULTS
RESULTS
Free-marginal kappa decreased between the initial impression of the attending physician and (1) the initial impression of the site investigator (
CONCLUSIONS
CONCLUSIONS
Considerable uncertainty surrounds the differential clinical diagnosis of sepsis vs. SIRS, especially before organ damage has become highly evident, and for patients presenting with respiratory clinical signs. Our findings underscore the need to provide physicians with accurate, timely diagnostic information in evaluating possible sepsis.
Identifiants
pubmed: 30828456
doi: 10.1186/s40560-019-0368-2
pii: 368
pmc: PMC6383290
doi:
Banques de données
ClinicalTrials.gov
['NCT02127502']
Types de publication
Journal Article
Langues
eng
Pagination
13Subventions
Organisme : AHRQ HHS
ID : K08 HS025240
Pays : United States
Organisme : NHLBI NIH HHS
ID : L30 HL124529
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL124099
Pays : United States
Déclaration de conflit d'intérêts
Ethics approval was gained from the relevant institutional review boards: Intermountain Medical Center/Latter Day Saints Hospital (1024931); Johns Hopkins Hospital (IRB00087839); Rush University Medical Center (15111104-IRB01); Loyola University Medical Center (208291); Northwell Healthcare (16-02-42-03); and Grady Memorial Hospital (000-87806).This manuscript does not contain any individual person’s data in any form. Therefore, consent for publication is not required.The authors have read the journal’s policy and declare the following competing interests: LM, TDY, AR, RBB, RAB, and TS are current or past employees and/or shareholders of Immunexpress.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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