ArticleHeliyon2022
Inter-expert agreement on indications for antibiotic therapy in older adults admitted to French hospital through an emergency department.
Article in Heliyon, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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6 authors.
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Abstract
Background: Around one third of older adults with infections have an atypical presentation upon admission to an emergency department (ED). Objective: To evaluate the level of agreement between experts from several disciplines on the indication for antibiotic therapy for a bacterial infection in older patients presenting at an ED, and to describe the characteristics of the infections. Methods: Based on comprehensive medical records, three experts (a geriatrician, an emergency physician (EP), and an infectious disease specialist (IDS)) determined independently and then jointly whether a patient presenting at the ED had a bacterial infection requiring antibiotic therapy. Inter-expert agreement was expressed as a fixed-marginal Fleiss' kappa (κ). Results: Of the 444 medical records included, the consensus meeting found that 114 (25.7%) had an indication for antibiotics, 327 (73.6%) did not have an indication, and 3 could not be classified. The overall level of agreement was 85.2%, and κ[95%CI] was 0.64 [0.57-0.72] (p < 0.001). The level of agreement between the geriatrician and the IDS (89.41%, κ0.73, 95%CI [0.62-0.85] (p < 0.001)) was higher than that between the geriatrician and the EP (83.56%, κ0.62, 95%CI [0.51-0.73] (p < 0.001)) and between the IDS and the EP (82.66%, κ0.59, 95%CI [0.48-0.70] (p < 0.001)). The levels of agreement between the final adjudication, was higher for the geriatrician, and IDS respectively 94.1% (κ0.85, 95%CI [0.74-0.97] (p < 0.001) and 94.4% (κ0.86, 95%CI [0.74-0.97] (p < 0.001)). 114 (25.7%) patients had a bacterial infection (mostly lung infections (n = 55, 48.2%) and urinary tract infections (n = 25, 21.9%)), and 28 patients (6.3%) had a viral infection. Conclusion: Our results highlighted substantial agreement between members of a multidisciplinary expert panel.
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