Variability in the Diagnosis of Surgical Site Infections After Full-Thickness Skin Grafting: An International Survey

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Variability in the Diagnosis of Surgical Site Infections After Full-Thickness Skin Grafting : An International Survey. / Palmgren, Johan; Paoli, John; Schmidtchen, Artur; Saleh, Karim.

I: British Journal of Dermatology, Vol. 180, Nr. 5, 2019, s. 1169-1175.

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TY - JOUR

T1 - Variability in the Diagnosis of Surgical Site Infections After Full-Thickness Skin Grafting

T2 - An International Survey

AU - Palmgren, Johan

AU - Paoli, John

AU - Schmidtchen, Artur

AU - Saleh, Karim

N1 - This article is protected by copyright. All rights reserved.

PY - 2019

Y1 - 2019

N2 - BACKGROUND: Diagnosis of a surgical site infection (SSI) in dermatologic surgery can be entirely based on a subjective assessment according to the 4th criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control (CDC).OBJECTIVES: To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.METHODS: An international electronic photographic survey with eight photographs of wounds 1 week after full-thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.RESULTS: A total of 393 dermatologists from 27 countries enrolled. Most respondents were from the United States (25%), followed by Sweden (24%) and the United Kingdom (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board-certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03), and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.CONCLUSION: This study reveals a broad inter-rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI. This article is protected by copyright. All rights reserved.

AB - BACKGROUND: Diagnosis of a surgical site infection (SSI) in dermatologic surgery can be entirely based on a subjective assessment according to the 4th criterion of the most common definition of an SSI, which was established by the US Centers for Disease Control (CDC).OBJECTIVES: To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.METHODS: An international electronic photographic survey with eight photographs of wounds 1 week after full-thickness skin grafting (FTSG) was sent to dermatologists. All wounds were assessed in terms of visual criteria beforehand. Data collected from respondents included physician characteristics and experience, and SSI assessments of all wounds.RESULTS: A total of 393 dermatologists from 27 countries enrolled. Most respondents were from the United States (25%), followed by Sweden (24%) and the United Kingdom (13%). There was only a slight interobserver agreement on SSI suspicion (κ = 0·19). SSI suspicion was lower for male physicians (P = 0·03), board-certified dermatologists (P = 0·001), physicians regularly assessing surgical wounds (P = 0·03), and physicians performing FTSG (P < 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.CONCLUSION: This study reveals a broad inter-rater variability in the diagnosis of SSI, illustrating the need for novel objective diagnostic methods that can better capture the variables that constitute an SSI. This article is protected by copyright. All rights reserved.

U2 - 10.1111/bjd.17517

DO - 10.1111/bjd.17517

M3 - Article

C2 - 30536813

VL - 180

SP - 1169

EP - 1175

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 1365-2133

IS - 5

ER -