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Won’t you be missing data on patients seen but not admitted?

Jan 21, ’12 2:50 AM

This issue of missing the ‘non-admitted’ patients has been a massive source of anxiety for us. It is only relevant if you are following the ‘all referrals’ or ‘prospective data flow’ approach. In which case, then we have to completely depend on the quality of the initial data capture.

If a month’s data can only be completed by ‘backfilling’ (i.e. pulling notes) then we will flag that as a time period where it is likely that the patients not admitted are a biased sample. Where there is little ‘backfilling’ then we can be more sure that we have not missed patients seen but not admitted.

We will not discard any data but this will permit us to run a sensitivity analysis and makes sure that our conclusions are not affected by months with different levels of data completeness.

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Aaahhh … why is my DVR report so long?

Jan 3, ’12 6:31 PM

First of all we are very pleased with the data quality for (SPOT)light. We expect around 2-3 errors per record (on average) and the average is around 0.5 (or 1 every two records). However, if you have a large number of records then this still translates into a large number of checks and a lot of work.

So to justify this then here are a few of the most common DVR checks with an explanation to justify why we are asking for your help:

  • Unusual spelling for first names: We will be unable to match to death certificates with the Office of National Statistics if the name spelling is odd. We expect some false positives with unusual names but the system should learn as we go along. Unfortunately a decent number of records across the entire study have first and last name reversed, and so despite the false positives this is still an important check.
  • Follow-up or recommended level of care missing. We’ll use this to classify patients  - especially important is the case where treatment limits are in place and we don’t want to consider that patient’s subsequent death outside of ICU as unanticipated.

I’ll add other explanations as they come up.

Please do get in contact if you have any queries.

Steve

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Happy New Year … and a DVR explanation

Jan 3, ’12 6:25 PM

Q: Why are you asking me to confirm a blank field?

A: Nearly all the fields on the web site have a ‘Not available’ checkbox attached, and when you have checked this then we will not be asking you for further information. However, if the field is blank and the box is unchecked then we need to be sure that form is complete and the data is truly unavailable.

The only other time we will ask is where there are also ‘drop-down’ lists since these do not have paired ‘Not available’ checkboxes.  The only way that we can be sure that the data in these fields is truly unavailable is by asking you to confirm this.

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Heads’n'Tails matching

Oct 28, ’11 4:36 AM

So the new Heads’n'Tails matching is ready. Hooray! I will be sending out your individual site sheets over the next few days. Please also have a look at the guidance notes.

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What if the baseline CXR is clear?

Aug 2, ’11 10:43 AM

Question: With the current screening regime, and the screening out if the CXR result is reported clear, you are quite likely to miss a large part of the viral pneumonias I would think. It may be conceivable that a patient indeed is quite unwell, but nonetheless is deemed to have a viral pathology, so antibiotics are stopped. So while he may need respiratory support, and be a candidate for the study in the spirit of the trial, we would have to filter him/her out. Was this intentional and pre-planned or just unavoidable?

Answer: So a clear CXR is not an exclusion (just something we might stratify differently). The CXR can be used to rule out a case if a different diagnosis is confirmed but to use a cliché (sorry) “absence of evidence isn’t …”. However, this leaves us with the sticky problem of exacerbation of COPD. To distinguish an exacerbation of COPD from pneumonia then it will be necessary for the CXR to have pneumonic changes. Sorry this is not 100% consistent but I think it gets at the spirit of the study.

 

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Is a tracheostomy a clinical event in (SPOT)id?

Aug 2, ’11 10:13 AM

Question: One of our SpotID patients had a percutaneous tracheostomy performed – I assume this is an “event” (on the daily CRF sheet) but cannot find a code for it within the coding system.

Answer: One the one hand I probably wouldn’t code this as an event on the ground that assuming it went well it shouldn’t be a cause of major physiological disturbance but if the patient was sedated and this affected the physiological observations then please use the code 1.1.1.x.x. which is Surgery/Respiratory/Upper Airway/x/x … (the ‘x’s meaning that there is no more specific code beyond this level).  If you have written a diagnosis in the free text then we’ll be fine with that.

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Hourly urines

Jul 25, ’11 7:36 AM

On the SpotID CRF the hourly urine output is requested.  For some patients the urine output is not measured hourly – so there may be a recording of, say, 300ml on the observation chart – but this will be for a few hours not one.  Do you want this figure added to the hourly urine box(es) on the CRF?

No.

The number should always be an hourly total. If hourly measurements were not available at the first hour after the start of the time period then please use the 2nd (or 3rd of 4th if necessary). If you are confident that the 300ml accurately summarises the 4 hour observation period then it would be acceptable to divide this by 4 and enter the answer (75). If you are not confident then better just to stick with 24 hour totals.

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The platelet count was not available to calculate the Day 4 SOFA score. What should I do?

Jul 8, ’11 3:09 PM

When you come to estimate the SOFA score on day 4 to decide if the patient should continue under follow-up then please follow the ‘last value carried forward’ principle. This means that you should use the last available value so if the platelet count was not measured on day 4 then you should use the value from day 3, if the day value is not available then the day 2 value and so on.

If the measurement has never been made then you will have to assume the value is normal and assign it a score of zero points.

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How to use the ICNARC coding method?

Jul 8, ’11 3:04 PM

Clear instructions and an online tool to generate the diagnostic code when patients are admitted with a diagnosis other than pneumonia (or) when you are reporting a major physiogical event during follow-up.

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Does a patient on noradrenaline score a point in CURB-65?

Jul 8, ’11 3:02 PM

Yes.

Patients with a systolic blood pressure <90, a fall in the systolic of >40 mmHg from baseline or those in receipt of vasopressors should score the “B” point in CURB-65. Similarly if the urea < 7 mmol/l but the patient is receiving renal replacement therapy, or if the patient is ventilated but the respiratory rate is <30 then these would count toward the CURB-65 score.

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