title: Surveillance versus clinical adjudication: differences persist with new ventilator-associated event definition.
abstract: BACKGROUND
  The National Healthcare Safety Network (NHSN) has recently supported efforts to shift surveillance away from ventilator-associated pneumonia to ventilator-associated events (VAEs) to decrease subjectivity in surveillance and minimize concerns over clinical correlation. The goals of this study were to compare the results of an automated surveillance strategy using the new VAE definition with a prospectively performed clinical application of the definition.
  
  
  METHODS
  All patients ventilated for ≥2 days in a medical and surgical intensive care unit were evaluated by 2 methods: retrospective surveillance using an automated algorithm combined with manual chart review after the NHSN's VAE methodology and prospective surveillance by pulmonary physicians in collaboration with the clinical team administering care to the patient at the bedside.
  
  
  RESULTS
  Overall, a similar number of events were called by each method (69 vs 67). Of the 1,209 patients, 56 were determined to have VAEs by both methods (κ = .81, P = .04). There were 24 patients considered to be a VAE by only 1 of the methods. Most discrepancies were the result of clinical disagreement with the NHSN's VAE methodology.
  
  
  CONCLUSIONS
  There was good agreement between the study teams. Awareness of the limitations of the surveillance definition for VAE can help infection prevention personnel in discussions with critical care partners about optimal use of these data.
authors.affiliation: Hospital Epidemiology and Infection Prevention Department, Barnes-Jewish Hospital, St Louis, MO. Electronic address: kmm2742@bjc.org.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: McMullen
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Boyer
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Noah
authors.initials: N
authors.lastname: Schoenberg
authors.affiliation: Division of Infectious Diseases, Washington University School of Medicine, St Louis, MO.
authors.forename: Hilary M
authors.initials: HM
authors.lastname: Babcock
authors.affiliation: St Louis College of Pharmacy, St Louis, MO.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Micek
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, MO.
authors.forename: Marin H
authors.initials: MH
authors.lastname: Kollef
mesh_terms: D000465:Algorithms; D003422:Critical Care / Q000379:methods / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012121:Respiration, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012122:Ventilators, Mechanical / Q000009:adverse effects*
keywords: Infections; Nosocomial; Pneumonia; Surveillance; Ventilator-associated