Surgical Outcomes and Analysis Unit of Clinical Analysis, Kaiser Permanente, San Diego, California 92109, USA.
Infect Control Hosp Epidemiol. 2011 Apr;32(4):351-9. doi: 10.1086/658942.
To evaluate whether a hybrid electronic screening algorithm using a total joint replacement (TJR) registry, electronic surgical site infection (SSI) screening, and electronic health record (EHR) review of SSI is sensitive and specific for SSI detection and reduces chart review volume for SSI surveillance.
Validation study.
A large health maintenance organization (HMO) with 8.6 million members.
Using codes for infection, wound complications, cellullitis, procedures related to infections, and surgeon-reported complications from the International Classification of Diseases, Ninth Revision, Clinical Modification, we screened each TJR procedure performed in our HMO between January 2006 and December 2008 for possible infections. Flagged charts were reviewed by clinical-content experts to confirm SSIs. SSIs identified by the electronic screening algorithm were compared with SSIs identified by the traditional indirect surveillance methodology currently employed in our HMO. Positive predictive values (PPVs), negative predictive values (NPVs), and specificity and sensitivity values were calculated. Absolute reduction of chart review volume was evaluated.
The algorithm identified 4,001 possible SSIs (9.5%) for the 42,173 procedures performed for our TJR patient population. A total of 440 case patients (1.04%) had SSIs (PPV, 11.0%; NPV, 100.0%). The sensitivity and specificity of the overall algorithm were 97.8% and 91.5%, respectively.
An electronic screening algorithm combined with an electronic health record review of flagged cases can be used as a valid source for TJR SSI surveillance. The algorithm successfully reduced the volume of chart review for surveillance by 90.5%.
评估使用关节置换（TJR）登记处、电子手术部位感染（SSI）筛查和电子病历（EHR）对 SSI 进行审查的混合电子筛查算法是否对 SSI 检测具有敏感性和特异性，并减少 SSI 监测的图表审查量。
验证研究。
拥有 860 万成员的大型医疗保健组织（HMO）。
使用国际疾病分类，第九版，临床修正版中的感染、伤口并发症、蜂窝织炎、与感染相关的程序以及外科医生报告的并发症的代码，我们对 2006 年 1 月至 2008 年 12 月期间我们 HMO 中进行的每一次 TJR 手术进行了感染筛查。由临床内容专家审查标记的图表以确认 SSI。将电子筛查算法识别的 SSI 与我们 HMO 目前使用的传统间接监测方法识别的 SSI 进行比较。计算阳性预测值（PPV）、阴性预测值（NPV）、特异性和敏感性值。评估图表审查量的绝对减少。
该算法确定了我们 TJR 患者人群中进行的 42173 例手术中可能发生的 4001 例 SSI（9.5%）。共有 440 例病例患者（1.04%）患有 SSI（PPV，11.0%；NPV，100.0%）。总体算法的灵敏度和特异性分别为 97.8%和 91.5%。
电子筛查算法与电子病历中标记病例的审查相结合可作为 TJR SSI 监测的有效来源。该算法成功地将监测的图表审查量减少了 90.5%。
