Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department

• Published in: Heliyon 2022-11, Vol.8 (11), p.e11630-e11630, Article e11630
• Main Authors: Coulongeat, Matthieu, Polisset, Nathalie, Poitau, Fanny, Laurent, Emeline, Fougère, Bertrand, Lemaignen, Adrien
• Format: Article
• Language: English
• Subjects: Aged 80 and over; Antibiotic therapy; Bacterial infections; Decision-making; Emergency department; Hospital; Inter-expert agreement
• ISSN: 2405-8440; 2405-8440
• DOI: 10.1016/j.heliyon.2022.e11630

Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in older patients presenting at an ED, and to describe the characteristics of the infections. Based on comprehensive medical records, three experts (a geriatrician, an emergency physician (EP), and an infectious disease specialist (IDS)) determined independently and then jointly whether a patient presenting at the ED had a bacterial infection requiring antibiotic therapy. Inter-expert agreement was expressed as a fixed-marginal Fleiss’ kappa (κ). Of the 444 medical records included, the consensus meeting found that 114 (25.7%) had an indication for antibiotics, 327 (73.6%) did not have an indication, and 3 could not be classified. The overall level of agreement was 85.2%, and κ[95%CI] was 0.64 [0.57–0.72] (p < 0.001). The level of agreement between the geriatrician and the IDS (89.41%, κ0.73, 95%CI [0.62–0.85] (p < 0.001)) was higher than that between the geriatrician and the EP (83.56%, κ0.62, 95%CI [0.51–0.73] (p < 0.001)) and between the IDS and the EP (82.66%, κ0.59, 95%CI [0.48–0.70] (p < 0.001)). The levels of agreement between the final adjudication, was higher for the geriatrician, and IDS respectively 94.1% (κ0.85, 95%CI [0.74–0.97] (p < 0.001) and 94.4% (κ0.86, 95%CI [0.74–0.97] (p < 0.001)). 114 (25.7%) patients had a bacterial infection (mostly lung infections (n = 55, 48.2%) and urinary tract infections (n = 25, 21.9%)), and 28 patients (6.3%) had a viral infection. Our results highlighted substantial agreement between members of a multidisciplinary expert panel. •Experts from different disciplines showed substantial agreement in deciding on the requirement of antibiotics•The level of inter-expert agreement depended on the physicians' medical specialties•Most of the bacterial infections were lung infections and urinary tract infections•This study is the first step towards to better identification of infections with an atypical presentation of infections Emergency department; Hospital; Bacterial infections; Decision-making; Aged 80 and over; Inter-expert agreement; Antibiotic therapy.