title: Agreement among healthcare professionals in ten European countries in diagnosing case-vignettes of surgical-site infections.
abstract: OBJECTIVE
  Although surgical-site infection (SSI) rates are advocated as a major evaluation criterion, the reproducibility of SSI diagnosis is unknown. We assessed agreement in diagnosing SSI among specialists involved in SSI surveillance in Europe.
  
  
  METHODS
  Twelve case-vignettes based on suspected SSI were submitted to 100 infection-control physicians (ICPs) and 86 surgeons in 10 European countries. Each participant scored eight randomly-assigned case-vignettes on a secure online relational database. The intra-class correlation coefficient (ICC) was used to assess agreement for SSI diagnosis on a 7-point Likert scale and the kappa coefficient to assess agreement for SSI depth on a three-point scale.
  
  
  RESULTS
  Intra-specialty agreement for SSI diagnosis ranged across countries and specialties from 0.00 (95%CI, 0.00-0.35) to 0.65 (0.45-0.82). Inter-specialty agreement varied from 0.04 (0.00-0.62) in to 0.55 (0.37-0.74) in Germany. For all countries pooled, intra-specialty agreement was poor for surgeons (0.24, 0.14-0.42) and good for ICPs (0.41, 0.28-0.61). Reading SSI definitions improved agreement among ICPs (0.57) but not surgeons (0.09). Intra-specialty agreement for SSI depth ranged across countries and specialties from 0.05 (0.00-0.10) to 0.50 (0.45-0.55) and was not improved by reading SSI definition.
  
  
  CONCLUSIONS
  Among ICPs and surgeons evaluating case-vignettes of suspected SSI, considerable disagreement occurred regarding the diagnosis, with variations across specialties and countries.
authors.affiliation: Infection control unit, Bichat-Claude Bernard Hospital, Paris, France. gbirgand@gmail.com
authors.forename: Gabriel
authors.initials: G
authors.lastname: Birgand
authors.forename: Didier
authors.initials: D
authors.lastname: Lepelletier
authors.forename: Gabriel
authors.initials: G
authors.lastname: Baron
authors.forename: Steve
authors.initials: S
authors.lastname: Barrett
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Breier
authors.forename: Cagri
authors.initials: C
authors.lastname: Buke
authors.forename: Ljiljana
authors.initials: L
authors.lastname: Markovic-Denic
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.forename: Jan
authors.initials: J
authors.lastname: Kluytmans
authors.forename: Outi
authors.initials: O
authors.lastname: Lyytikainen
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sheridan
authors.forename: Emese
authors.initials: E
authors.lastname: Szilagyi
authors.forename: Evelina
authors.initials: E
authors.lastname: Tacconelli
authors.forename: Nicolas
authors.initials: N
authors.lastname: Troillet
authors.forename: Philippe
authors.initials: P
authors.lastname: Ravaud
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Lucet
mesh_terms: D002983:Clinical Competence; D003428:Cross Infection; D005060:Europe; D006282:Health Personnel; D006801:Humans; D010820:Physicians; D011785:Quality Assurance, Health Care; D013530:Surgical Wound Infection / Q000175:diagnosis*