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Evolving to Better Metrics for Nonventilator Hospital-Acquired Pneumonia: Is Electronic Surveillance the Answer?

Reviewed by Sonali Advani, MBBS, MPH; Duke University School of Medicine

Traditional surveillance methods involve manual chart review and subjective implementation of multidimensional definitions which are error-prone, time-consuming, and susceptible to assessment bias. Ji and colleagues propose surveillance definitions for nonventilator hospital acquired pneumonia (NV-HAP) using structured data from electronic health records (EHRs) rather than manual review of EHRs. The definitions all included worsening oxygenation as a criterion, and 9 of 10 included starting the patient on a new antibiotic at least 3 days after hospital admission and continuing administration for at least 3 days. 

Among 311,484 admissions across 4 hospitals during a 3-year period, incidence rates (per 100 admissions) ranged from 3.4 events for worsening oxygenation alone to 0.6 event for worsening oxygenation, at least 3 days of new antibiotics, fever, abnormal white blood cell count, and performance of chest imaging. Crude mortality rates ranged from 16.1% to 27.7%, respectively. However, the study found that the 2 tertiary care hospitals had higher incidence rates of NV-HAP compared to the 2 community hospitals. These differences may be due to factors inherent to the underlying patient population and hence, risk adjustment to these definitions may be needed. While the proposed definitions for NV-HAP offer a novel yet practical framework for performing surveillance, we have a limited understanding of the sensitivity and specificity of these definitions and whether they capture truly preventable events. 

References:

Ji W, McKenna C, Ochoa A, et al. Development and Assessment of Objective Surveillance Definitions for Nonventilator Hospital-Acquired Pneumonia. JAMA Netw Open. Published online October 18, 20192(10):e1913674. doi:10.1001/jamanetworkopen.2019.13674

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