Adjudication instrument for infection in critically injured trauma patients

Background: Approximately one in four trauma patients admitted to the intensive care unit (ICU) develops an infection, resulting in 20% mortality. In trauma patients, it is difficult to distinguish the systemic inflammation due to injury from infection. Lack of a gold standard for diagnosing infection further complicates recognition and management of sepsis in this population. We developed and piloted an adjudication instrument to analyze infection status in critically injured trauma patients. Methods: Adult trauma patients admitted to the ICU (January-October 2022) were included. Our multidisciplinary adjudication committee of six clinical experts collaboratively developed the case report form (CRF) and infection status form. The CRFs have structured clinical data, and the infection status form includes the likelihood of infection on a Likert scale, site, and type of infection. Two adjudicators were randomly assigned to independently review the CRF and complete the infection status form. If both provided concordant responses, consensus was achieved. If there was a discrepancy in responses, a third adjudicator was assigned to review. Results: 40 patients underwent adjudication of infection status. Concordance between the two primary adjudicators was found in 82.5% (33/40). Of these, infection was identified in 18.2% (6/33). In all cases, adjudicators assessed a lung source of bacterial infection. Seven cases were reviewed by a third adjudicator, and infection was identified in 85.7% (6/7). Conclusions: In the absence of a gold standard for the diagnosis of infection in critically injured trauma patients, an adjudication process can be an effective way to standardize the assessment of a study event or endpoint. Level of evidence: Diagnostic tests or criteria; level II.