{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:06:42Z","timestamp":1792789602317,"version":"4.5.0"},"reference-count":12,"publisher":"SAGE Publications","issue":"10-11","license":[{"start":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T00:00:00Z","timestamp":1692403200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Stichting Gezondheidszorg Spaarneland (SGS) Fund, Zilveren Kruis Achmea"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Int J Artif Organs"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>Infectious complications are common during extracorporeal membrane oxygenation (ECMO) and may negatively impact outcomes. However, there is considerable variation in the reported rates of incidence, which hampers the use of infections as a quality benchmark for ECMO centers. To assess the contributing role of poor interrater agreement, three independent raters reviewed medical records from all intensive care unit (ICU) patients who received ECMO for &gt;24\u2009h in our tertiary center between October 2019 and October 2021 for suspected episodes of infection, which were rated based on their date of onset and presumed site\/diagnosis. To establish a gold standard, any discrepancies were resolved using an expert panel consisting of two intensivists\/infectious disease specialists. During 83 ECMO-runs in 77 patients, we observed a total of 62 adjudicated infectious episodes (incidence rate 62, 95% CI: 48\u201380, per 1000\u2009days at risk). Among 81 episodes suspected by at least one observer, 66 (81%) were identified by two, and only 44 (54%) by all three raters, resulting in Fleiss\u2019 kappa of 0.10 (95% CI: 0.00\u20130.19; slight agreement). However, if raters concurred regarding infection onset, subsequent agreement on infection site was good (concordance 89%; kappa 0.85, 95% CI: 0.72\u20130.98; near perfect agreement). In conclusion, adjudication of infectious episodes during ECMO is associated with poor interrater agreement regarding occurrence\u2014but not site\u2014of infection. This finding might partially explain the significant disparities observed in reported infection rates during ECMO, emphasizing the need for caution when interpreting infection data in this particular population due to the potential for inherent measurement error.<\/jats:p>","DOI":"10.1177\/03913988231193448","type":"journal-article","created":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T08:10:48Z","timestamp":1692432648000},"page":"597-601","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":2,"title":["Interrater agreement in classifying infections during extracorporeal membrane oxygenation"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5882-4980","authenticated-orcid":false,"given":"Karlijn","family":"Verkerk","sequence":"first","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara CA","family":"Pladet","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christiaan L","family":"Meuwese","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Thoraxcenter, Erasmus, Rotterdam, The Netherlands"},{"name":"Department of Intensive Care, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6496-2768","authenticated-orcid":false,"given":"Dirk W","family":"Donker","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands"},{"name":"Cardiovascular and Respiratory Physiology, TechMed Center, University of Twente, Enschede, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lennie PG","family":"Derde","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf L","family":"Cremer","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,8,19]]},"reference":[{"key":"bibr1-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1016\/S1441-2772(23)01792-1"},{"key":"bibr2-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05847-z"},{"key":"bibr3-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2017.02.025"},{"key":"bibr4-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000002652"},{"key":"bibr5-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1086\/668439"},{"key":"bibr6-03913988231193448","doi-asserted-by":"publisher","DOI":"10.21037\/acs.2018.11.03"},{"key":"bibr7-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1415236"},{"key":"bibr8-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3182923712"},{"key":"bibr9-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1037\/h0031619"},{"key":"bibr10-03913988231193448","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"bibr11-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-019-05883-9"},{"key":"bibr12-03913988231193448","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.19709"}],"container-title":["The 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