Haley R W, Schaberg D R, McClish D K, Quade D, Crossley K B, Culver D H, Morgan W M, McGowan J E, Shachtman R H
Am J Epidemiol. 1980 May;111(5):516-33. doi: 10.1093/oxfordjournals.aje.a112931.
To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.
为评估一种标准化方法——回顾性病历审查（RCR）——用于估算各医院医院感染率（NIR）的准确性和一致性，作者在四家不同类型的医院开展了一系列预试验研究。与基于监督密集前瞻性数据收集团队的内科流行病学家所做诊断的标准相比，发现RCR方法的平均灵敏度为0.74（±0.02标准误；范围0.69 - 0.78），平均特异度为0.964（±0.002；0.945 - 0.991）。这些数值与内科流行病学家的诊断结果相当，且在各医院之间的差异较小。发现两个独立的病历审查团队具有相似水平的灵敏度和特异度，且单个病历审查员的诊断可靠性平均为0.94。在实际病历调查（MRS）中点时，对其中一家预试验医院进行的重新研究中，由于在最初预试验研究后对RCR方法进行了改进，灵敏度大幅提高，特异度略有增加。
