PMID- 24878451
OWN - NLM
STAT- MEDLINE
DCOM- 20150609
LR  - 20211021
IS  - 1545-0066 (Electronic)
IS  - 1090-3127 (Print)
IS  - 1090-3127 (Linking)
VI  - 18
IP  - 4
DP  - 2014 Oct-Dec
TI  - A comparative assessment of adverse event classification in the out-of-hospital 
      setting.
PG  - 495-504
LID - 10.3109/10903127.2014.916022 [doi]
AB  - OBJECTIVES: We sought to test reliability of two approaches to classify adverse 
      events (AEs) associated with helicopter EMS (HEMS) transport. METHODS: The first 
      approach for AE classification involved flight nurses and paramedics (RN/Medics) 
      and mid-career emergency physicians (MC-EMPs) independently reviewing 50 randomly 
      selected HEMS medical records. The second approach involved RN/Medics and MC-EMPs 
      meeting as a group to openly discuss 20 additional medical records and reach 
      consensus-based AE decision. We compared all AE decisions to a reference 
      criterion based on the decision of three senior emergency physicians (Sr-EMPs). 
      We designed a study to detect an improvement in agreement (reliability) from fair 
      (kappa = 0.2) to moderate (kappa = 0.5). We calculated sensitivity, specificity, 
      percent agreement, and positive and negative predictive values (PPV/NPV). 
      RESULTS: For the independent reviews, the Sr-EMP group identified 26 AEs while 
      individual clinician reviewers identified between 19 and 50 AEs. Agreement on the 
      presence/absence of an AE between Sr-EMPs and three MC-EMPs ranged from kappa = 0.20 
      to kappa = 0.25. Agreement between Sr-EMPs and three RN/Medics ranged from kappa = 0.11 
      to kappa = 0.19. For the consensus/open-discussion approach, the Sr-EMPs identified 
      13 AEs, the MC-EMP group identified 18 AEs, and RN/medic group identified 36 AEs. 
      Agreement between Sr-EMPs and MC-EMP group was (kappa = 0.30 95%CI -0.12, 0.72), 
      whereas agreement between Sr-EMPs and RN/medic group was (kappa = 0.40 95%CI 0.01, 
      0.79). Agreement between all three groups was fair (kappa = 0.33, 95%CI 0.06, 0.66). 
      Percent agreement (58-68%) and NPV (63-76%) was moderately dissimilar between 
      clinicians, while sensitivity (25-80%), specificity (43-97%), and PPV (48-83%) 
      varied. CONCLUSIONS: We identified a higher level of agreement/reliability in AE 
      decisions utilizing a consensus-based approach for review rather than independent 
      reviews.
FAU - Patterson, P Daniel
AU  - Patterson PD
FAU - Lave, Judith R
AU  - Lave JR
FAU - Weaver, Matthew D
AU  - Weaver MD
FAU - Guyette, Francis X
AU  - Guyette FX
FAU - Arnold, Robert M
AU  - Arnold RM
FAU - Martin-Gill, Christian
AU  - Martin-Gill C
FAU - Rittenberger, Jon C
AU  - Rittenberger JC
FAU - Krackhardt, David
AU  - Krackhardt D
FAU - Mosesso, Vincent N
AU  - Mosesso VN
FAU - Roth, Ronald N
AU  - Roth RN
FAU - Wadas, Richard J
AU  - Wadas RJ
FAU - Yealy, Donald M
AU  - Yealy DM
LA  - eng
GR  - KL2 TR000146/TR/NCATS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
DEP - 20140530
PL  - England
TA  - Prehosp Emerg Care
JT  - Prehospital emergency care
JID - 9703530
SB  - IM
MH  - Air Ambulances/*statistics & numerical data
MH  - Consensus
MH  - Emergency Medical Services/*statistics & numerical data
MH  - Humans
MH  - Medical Errors/*statistics & numerical data
MH  - Predictive Value of Tests
MH  - Quality Indicators, Health Care
MH  - Reproducibility of Results
MH  - Sensitivity and Specificity
MH  - United States
PMC - PMC4410777
MID - NIHMS592958
OTO - NOTNLM
OT  - adverse events
OT  - measurement
OT  - reliability
OT  - safety
EDAT- 2014/06/01 06:00
MHDA- 2015/06/10 06:00
PMCR- 2015/10/01
CRDT- 2014/06/01 06:00
PHST- 2014/06/01 06:00 [entrez]
PHST- 2014/06/01 06:00 [pubmed]
PHST- 2015/06/10 06:00 [medline]
PHST- 2015/10/01 00:00 [pmc-release]
AID - 10.3109/10903127.2014.916022 [doi]
PST - ppublish
SO  - Prehosp Emerg Care. 2014 Oct-Dec;18(4):495-504. doi: 
      10.3109/10903127.2014.916022. Epub 2014 May 30.