Purpose
Surgical site infection (SSI) can be a challenging complication after hand surgery.
Retrospective studies often rely on chart review to determine presence of an SSI.
The purpose of this study was to assess reliability of Centers for Disease Control
and Prevention (CDC) criteria for determining an SSI as applied to a chart review.
We hypothesized that interobserver and intraobserver reliability for determining an
SSI using these criteria while reviewing medical record documentation would be none
to minimal (κ < 0.39) based on an interpretation of Cohen’s κ statistics.
Methods
We created and used a database of 782 patients, 48 of whom received antibiotics within
3 months of a surgical procedure of the hand. Three fellowship-trained orthopedic
hand surgeons then evaluated the charts of those 48 patients, in which each reviewer
determined whether an SSI was present or absent based on CDC criteria provided to
the reviewers. Patients’ charts were then reassessed 1 month later by the same reviewers.
Kappa statistics were calculated for each round of assessment and averaged to determine
intraobserver and interobserver reliability.
Results
Overall κ values were 0.22 (standard error, 0.13), indicating fair reliability. Average
κ value between reviewers was 0.26 (standard error, 0.13. On average, intrarater reliability
was 68.7%.
Conclusions
We found poor interobserver and intraobserver reliability when using CDC criteria
to determine whether a patient had an SSI, based on chart review.
Clinical relevance
Better criteria or documentation may be needed in patients with an infection after
hand surgery. Retrospective chart reviews to assess infection may be unreliable.
Key words
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Article info
Publication history
Published online: July 18, 2020
Accepted:
May 27,
2020
Received:
July 16,
2019
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2020 by the American Society for Surgery of the Hand. All rights reserved.
