title: Accuracy of electronic surveillance of catheter-associated urinary tract infection at an academic medical center.
abstract: OBJECTIVE
  To develop and validate a methodology for electronic surveillance of catheter-associated urinary tract infections (CAUTIs).
  
  
  METHODS
  Diagnostic accuracy study.
  
  
  METHODS
  A 425-bed university hospital.
  
  
  METHODS
  A total of 1,695 unique inpatient encounters from November 2009 through November 2010 with a high clinical suspicion of CAUTI.
  
  
  METHODS
  An algorithm was developed to identify incident CAUTIs from electronic health records (EHRs) on the basis of the Centers for Disease Control and Prevention (CDC) surveillance definition. CAUTIs identified by electronic surveillance were compared with the reference standard of manual surveillance by infection preventionists. To determine diagnostic accuracy, we created 2 × 2 tables, one unadjusted and one adjusted for misclassification using chart review and case adjudication. Unadjusted and adjusted test statistics (percent agreement, sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV], and κ) were calculated.
  
  
  RESULTS
  Electronic surveillance identified 64 CAUTIs compared with manual surveillance, which identified 19 CAUTIs for 97% agreement, 79% sensitivity, 97% sensitivity, 23% PPV, 100% NPV, and κ of .33. Compared with the reference standard adjusted for misclassification, which identified 55 CAUTIs, electronic surveillance had 98% agreement, 80% sensitivity, 99% specificity, 69% PPV, 99% NPV, and κ of .71.
  
  
  CONCLUSIONS
  The electronic surveillance methodology had a high NPV and a low PPV compared with the reference standard, indicating a role of the electronic algorithm in screening data sets to exclude cases. However, the PPV markedly improved compared with the reference standard adjusted for misclassification, suggesting a future role in surveillance with improvements in EHRs.
authors.affiliation: University of Colorado School of Medicine, Aurora, Colorado.
authors.forename: H L
authors.initials: HL
authors.lastname: Wald
authors.forename: B
authors.initials: B
authors.lastname: Bandle
authors.forename: A
authors.initials: A
authors.lastname: Richard
authors.forename: S
authors.initials: S
authors.lastname: Min
mesh_terms: D000046:Academic Medical Centers; D000465:Algorithms; D055499:Catheter-Related Infections / Q000175:diagnosis*; D003428:Cross Infection / Q000175:diagnosis*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D011159:Population Surveillance / Q000379:methods; D012680:Sensitivity and Specificity; D014552:Urinary Tract Infections / Q000175:diagnosis*