Identifying surgical site infections in electronic health data using predictive models.

TitleIdentifying surgical site infections in electronic health data using predictive models.
Publication TypeJournal Article
Year of Publication2018
AuthorsGrundmeier RW, Xiao R, Ross RK, Ramos MJ, Karavite DJ, Michel JJ, Gerber JS, Coffin SE
JournalJ Am Med Inform Assoc
Date Published2018 Jun 29
ISSN1527-974X
Abstract

Objective: The objective was to prospectively derive and validate a prediction rule for detecting cases warranting investigation for surgical site infections (SSI) after ambulatory surgery.

Methods: We analysed electronic health record (EHR) data for children who underwent ambulatory surgery at one of 4 ambulatory surgical facilities. Using regularized logistic regression and random forests, we derived SSI prediction rules using 30 months of data (derivation set) and evaluated performance with data from the subsequent 10 months (validation set). Models were developed both with and without data extracted from free text. We also evaluated the presence of an antibiotic prescription within 60 days after surgery as an independent indicator of SSI evidence. Our goal was to exceed 80% sensitivity and 10% positive predictive value (PPV).

Results: We identified 234 surgeries with evidence of SSI among the 7910 surgeries available for analysis. We derived and validated an optimal prediction rule that included free text data using a random forest model (sensitivity = 0.9, PPV = 0.28). Presence of an antibiotic prescription had poor sensitivity (0.65) when applied to the derivation data but performed better when applied to the validation data (sensitivity = 0.84, PPV = 0.28).

Conclusions: EHR data can facilitate SSI surveillance with adequate sensitivity and PPV.

DOI10.1093/jamia/ocy075
Alternate JournalJ Am Med Inform Assoc
PubMed ID29982511