title: Automated surveillance for ventilator-associated events.
abstract: BACKGROUND
  The US Centers for Disease Control and Prevention has implemented a new, multitiered definition for ventilator-associated events (VAEs) to replace their former definition of ventilator-associated pneumonia (VAP). We hypothesized that the new definition could be implemented in an automated, efficient, and reliable manner using the electronic health record and that the new definition would identify different patients than those identified under the previous definition.
  
  
  METHODS
  We conducted a retrospective cohort analysis using an automated algorithm to analyze all patients admitted to the ICU at a single urban, tertiary-care hospital from 2008 to 2013.
  
  
  RESULTS
  We identified 26,466 consecutive admissions to the ICU, 10,998 (42%) of whom were mechanically ventilated and 675 (3%) of whom were identified as having any VAE. Any VAE was associated with an adjusted increased risk of death (OR, 1.91; 95% CI, 1.53-2.37; P < .0001). The automated algorithm was reliable (sensitivity of 93.5%, 95% CI, 77.2%-98.8%; specificity of 100%, 95% CI, 98.8%-100% vs a human abstractor). Comparison of patients with a VAE and with the former VAP definition yielded little agreement (κ = 0.06).
  
  
  CONCLUSIONS
  A fully automated method of identifying VAEs is efficient and reliable within a single institution. Although VAEs are strongly associated with worse patient outcomes, additional research is required to evaluate whether and which interventions can successfully prevent VAEs.
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA; Division for Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA. Electronic address: jpsteven@bidmc.harvard.edu.
authors.forename: Jennifer P
authors.initials: JP
authors.lastname: Stevens
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: George
authors.initials: G
authors.lastname: Silva
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA.
authors.forename: Jean
authors.initials: J
authors.lastname: Gillis
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA; Soroka Clinical Research Center, Soroka University Medical Center, Be'er Sheva, Israel.
authors.forename: Victor
authors.initials: V
authors.lastname: Novack
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Talmor
authors.affiliation: Harvard Medical School, Boston, MA; Division of Population Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
authors.affiliation: Center for Healthcare Delivery Science, Beth Israel Deaconess Medical Center, Boston, MA; Center for Quality, and Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Howell
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D001331:Automation / Q000379:methods; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D062606:Tertiary Care Centers; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D012122:Ventilators, Mechanical / Q000009:adverse effects; D055815:Young Adult