Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department
Background: Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective: To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in olde...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2022-11-01
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| Series: | Heliyon |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405844022029188 |
| _version_ | 1828097979511209984 |
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| author | Matthieu Coulongeat Nathalie Polisset Fanny Poitau Emeline Laurent Bertrand Fougère Adrien Lemaignen |
| author_facet | Matthieu Coulongeat Nathalie Polisset Fanny Poitau Emeline Laurent Bertrand Fougère Adrien Lemaignen |
| author_sort | Matthieu Coulongeat |
| collection | DOAJ |
| description | Background: Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective: 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. Methods: 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). Results: 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. Conclusion: Our results highlighted substantial agreement between members of a multidisciplinary expert panel. |
| first_indexed | 2024-04-11T07:54:24Z |
| format | Article |
| id | doaj.art-0164d749b46042799dd0ddf92e6af9eb |
| institution | Directory Open Access Journal |
| issn | 2405-8440 |
| language | English |
| last_indexed | 2024-04-11T07:54:24Z |
| publishDate | 2022-11-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Heliyon |
| spelling | doaj.art-0164d749b46042799dd0ddf92e6af9eb2022-12-22T04:35:58ZengElsevierHeliyon2405-84402022-11-01811e11630Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency departmentMatthieu Coulongeat0Nathalie Polisset1Fanny Poitau2Emeline Laurent3Bertrand Fougère4Adrien Lemaignen5Division of Geriatric Medicine, Tours University Medical Center, Tours, France; Tours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, France; Corresponding author.Tours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, France; Emergency Department, Tours University Medical Center, Tours, FranceDivision of Geriatric Medicine, Tours University Medical Center, Tours, France; Tours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, FranceTours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, France; Epidémiologie des Données Cliniques en Centre-Val de Loire (EpiDcliC), Centre Hospitalier Universitaire de Tours, Tours, France; Equipe de Recherche 'Education Ethique Santé' (EE1 EES), Université de Tours, Tours, FranceDivision of Geriatric Medicine, Tours University Medical Center, Tours, France; Tours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, France; Education, Ethics, Health (EA 7505), Tours University, Tours, FranceTours University Medical Center, Tours, 2 Boulevard Tonnellé 37044 TOURS, France; Service de Médecine Interne et Maladies Infectieuses (S2MI), Centre Hospitalier Universitaire de Tours, Tours, FranceBackground: Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective: 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. Methods: 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). Results: 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. Conclusion: Our results highlighted substantial agreement between members of a multidisciplinary expert panel.http://www.sciencedirect.com/science/article/pii/S2405844022029188Emergency departmentHospitalBacterial infectionsDecision-makingAged 80 and overInter-expert agreement |
| spellingShingle | Matthieu Coulongeat Nathalie Polisset Fanny Poitau Emeline Laurent Bertrand Fougère Adrien Lemaignen Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department Heliyon Emergency department Hospital Bacterial infections Decision-making Aged 80 and over Inter-expert agreement |
| title | Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department |
| title_full | Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department |
| title_fullStr | Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department |
| title_full_unstemmed | Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department |
| title_short | Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department |
| title_sort | inter expert agreement on indications for antibiotic therapy in older adults admitted to french hospital through an emergency department |
| topic | Emergency department Hospital Bacterial infections Decision-making Aged 80 and over Inter-expert agreement |
| url | http://www.sciencedirect.com/science/article/pii/S2405844022029188 |
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