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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 LU and Saleh, Karim LU (2018) In British Journal of Dermatology
Abstract

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... (More)

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.

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epub
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British Journal of Dermatology
publisher
Wiley-Blackwell
external identifiers
  • scopus:85061041393
ISSN
1365-2133
DOI
10.1111/bjd.17517
language
English
LU publication?
yes
id
d08685cd-9037-4e0f-a8a9-8f1b66cf63e6
date added to LUP
2019-01-15 09:48:59
date last changed
2019-02-13 09:35:35
@article{d08685cd-9037-4e0f-a8a9-8f1b66cf63e6,
  abstract     = {<p>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).</p><p>OBJECTIVES: To investigate the interobserver agreement between dermatologists in their diagnosis of SSI of dermatosurgical wounds.</p><p>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.</p><p>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 &lt; 0·001). Swedish physicians diagnosed more SSIs than US physicians (P = 0·002). Erythema was more common in cases with higher SSI suspicion.</p><p>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.</p>},
  author       = {Palmgren, Johan and Paoli, John and Schmidtchen, Artur and Saleh, Karim},
  issn         = {1365-2133},
  language     = {eng},
  month        = {12},
  publisher    = {Wiley-Blackwell},
  series       = {British Journal of Dermatology},
  title        = {Variability in the Diagnosis of Surgical Site Infections After Full-Thickness Skin Grafting : An International Survey},
  url          = {http://dx.doi.org/10.1111/bjd.17517},
  year         = {2018},
}