Is single observer identification of wound infection a reliable endpoint?

The majority of wound studies over the past 20 years have relied on single observer determination of infection presence or absence as a study endpoint. Nevertheless, there are few data on the reliability of those determinations. If single observer determinations are not reliable, the validity of stu...

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Bibliographic Details
Published in:The Journal of emergency medicine 2002-11, Vol.23 (4), p.333-335
Main Authors: Greenwald, Peter W., Schaible, Derek D., Ruzich, Jeffrey V., Prince, Sharon J., Birnbaum, Adrienne J., Bijur, Polly E.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age Distribution
Aged
Aged, 80 and over
Biological and medical sciences
Child
Child, Preschool
Clinical Competence
Cohort Studies
Cross-Sectional Studies
Female
Humans
Incidence
infection
Male
Medical sciences
Middle Aged
Miscellaneous
Observer Variation
outcomes
Practice Patterns, Physicians
Risk Factors
Sensitivity and Specificity
Severity of Illness Index
Sex Distribution
Trauma Centers
Traumas. Diseases due to physical agents
wound
Wound Infection - diagnosis
Wound Infection - epidemiology
Wound Infection - therapy
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Summary:The majority of wound studies over the past 20 years have relied on single observer determination of infection presence or absence as a study endpoint. Nevertheless, there are few data on the reliability of those determinations. If single observer determinations are not reliable, the validity of studies using this endpoint should be questioned. Two physicians independently evaluated wounds for presence or absence of the primary endpoint of infection and the secondary endpoints of purulence, tenderness, warmth, and erythema. Kappa values were calculated as measures of inter-observer agreement, which was used as a measure of reliability. Of 125 patients enrolled, 115 wounds were available for analysis. Kappa =.57 [95%CI.39 to .75] for the primary endpoint of infection, .84 for purulence, .72 for tenderness, .48 for warmth, and .48 for erythema. Agreement on two features of infection and overall agreement on the presence or absence of wound infection was only ‘moderate.’ Single observer determination of wound infection by inexperienced observers using imprecise definitions, though commonly used, is an unreliable measure for scientific study.
ISSN:0736-4679
2352-5029
DOI:10.1016/S0736-4679(02)00564-4