title: Clinical Correlates of Surveillance Events Detected by National Healthcare Safety Network Pneumonia and Lower Respiratory Infection Definitions-Pennsylvania, 2011-2012.
abstract: OBJECTIVE To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events DESIGN Retrospective chart review SETTING A convenience sample of 8 acute-care hospitals in Pennsylvania PATIENTS All patients hospitalized during 2011-2012 METHODS Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded. RESULTS We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented. CONCLUSIONS In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015. Infect Control Hosp Epidemiol 2016;37:818-824.
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Isaac
authors.initials: I
authors.lastname: See
authors.affiliation: 3UCLA Geffen School of Medicine,Los Angeles,California.
authors.forename: Julia
authors.initials: J
authors.lastname: Chang
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Nicole
authors.initials: N
authors.lastname: Gualandi
authors.affiliation: 2Epidemic Intelligence Service,Center for Surveillance,Epidemiology and Laboratory Services,Centers for Disease Control and Prevention,Atlanta,GA.
authors.forename: Genevieve L
authors.initials: GL
authors.lastname: Buser
authors.affiliation: 5Pennsylvania Department of Health,Harrisburg,Pennsylvania.
authors.forename: Pamela
authors.initials: P
authors.lastname: Rohrbach
authors.affiliation: 5Pennsylvania Department of Health,Harrisburg,Pennsylvania.
authors.forename: Debra A
authors.initials: DA
authors.lastname: Smeltz
authors.affiliation: 6Excela Health Westmoreland Hospital,Greensburg,Pennsylvania.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Bellush
authors.affiliation: 7The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: 8St. Christopher's Hospital for Children,Philadelphia,Pennsylvania.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Gould
authors.affiliation: 9Lancaster General Hospital,Lancaster,PA.
authors.forename: Debra
authors.initials: D
authors.lastname: Hess
authors.affiliation: 8St. Christopher's Hospital for Children,Philadelphia,Pennsylvania.
authors.forename: Patricia
authors.initials: P
authors.lastname: Hennessey
authors.affiliation: 7The Children's Hospital of Philadelphia,Philadelphia,Pennsylvania.
authors.forename: Sydney
authors.initials: S
authors.lastname: Hubbard
authors.affiliation: 8St. Christopher's Hospital for Children,Philadelphia,Pennsylvania.
authors.forename: Andrea
authors.initials: A
authors.lastname: Kiernan
authors.affiliation: 10Pennsylvania Presbyterian Medical Center,Philadelphia,Pennsylvania.
authors.forename: Judith
authors.initials: J
authors.lastname: O'Donnell
authors.affiliation: 11University of Pennsylvania Health System,Philadelphia,Pennsylvania.
authors.forename: David A
authors.initials: DA
authors.lastname: Pegues
authors.affiliation: 12Office of Public Health Preparedness and Response,CDC,assigned to the Pennsylvania Department of Health,Harrisburg,Pennsylvania.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Miller
authors.affiliation: 1Division of Healthcare Quality Promotion,Centers for Disease Control and Prevention,Atlanta,Georgia.
authors.forename: Shelley S
authors.initials: SS
authors.lastname: Magill
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D053717:Pneumonia, Ventilator-Associated / Q000175:diagnosis / Q000453:epidemiology; D011159:Population Surveillance; D012141:Respiratory Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies