title: Trigger tool versus verbal inventory to detect surgical complications.
abstract: OBJECTIVE
  Traditionally, registering complications after surgery is based on voluntary reporting or incident reports. These methods may fail to detect the total number of complications. A trigger tool was developed to detect complications in hospitalized surgical patients. In this diagnostic study, we compared its sensitivity and specificity with the verbal inventory by surgical staff and residents.
  
  
  METHODS
  A set of 31 potential triggers was chosen based on a systematic review and availability in hospital databases. The trigger tool was developed using multivariable regression and Receiver Operating Characteristic (ROC) analyses. A reference standard consisted of 300 patients, 150 with and 150 without complications. Sensitivity and specificity of the trigger tool and verbal inventory were determined.
  
  
  RESULTS
  The final trigger tool consisted of nine triggers. Sensitivities of the trigger tool and verbal inventory were 70.7 vs. 78.7%, respectively, while specificities were 70.0 vs. 100.0%, respectively. Sensitivity values to detect major complications were 97.2 vs. 80.6%, respectively.
  
  
  CONCLUSIONS
  The proposed customized trigger tool for a university hospital to detect surgical patients with complications appeared as accurate as a verbal inventory and even more accurate to detect major complications.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. a.visser@amc.nl.
authors.forename: A
authors.initials: A
authors.lastname: Visser
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: A E
authors.initials: AE
authors.lastname: Slaman
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: C M
authors.initials: CM
authors.lastname: van Leijen
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: D J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: J C
authors.initials: JC
authors.lastname: Goslings
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, H1-213, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
authors.forename: D T
authors.initials: DT
authors.lastname: Ubbink
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006785:Hospitals, University; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000379:methods*; D008505:Medical Staff, Hospital; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D012372:ROC Curve; D012042:Registries; D012189:Retrospective Studies; D017751:Safety Management; D012680:Sensitivity and Specificity; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Complication; Predictor; Registration; Surgery; Trigger tool