Discordance between patient report and chart review of risk factors for antimicrobial resistance in ED patients

Objectives: The objective of this study is to identify the level of agreement between patient self-report and chart review for presence of antimicrobial resistance (AR) risk factors in emergency department (ED) patients. Methods: This is a cross-sectional analysis of adult ED patients from July 2010 to January 2011. All ED patients 18 years or older were eligible. Exclusion criteria included pregnant women, prisoners, altered mental status, non-English speakers, traumas, and patients unable to provide consent. Data were obtained by ED patient interview and review of the preceding 3 months of the medical record. We report the difference between patient self-report and chart review of identifying 1 or more AR risk factors using McNemar's chi(2). The test statistic was also calculated for individual risk factors and significance adjusted for multiple comparisons (P < .003). Agreement was calculated using kappa with 95% confidence intervals (CIs). Risk factor domains assessed included nursing home residence, recent health care utilization, current indwelling devices, and medical history. Results: Among 289 patients, 1 or more risk factors were reported by 68% (95% CI, 63%-74%) of patients and found in 59% (95% CI, 53%-65%) of charts, a difference of 9.7% (95% CI, 5.3%-14%) (P < .001; kappa = 0.72). Patients were more likely to report recent antibiotic use (42% vs 29%; P < .001; kappa = 0.52) and recent surgery (17% vs 11%; P < .001; kappa = 0.64). Conclusions: There is disagreement between ED patient self-report and medical record review for many AR risk factors. This could affect both clinical care and results of ED research studies relying on chart reviews. Patient self-report identifies a greater number of AR risk factors than chart review. (C) 2013 Elsevier Inc. All rights reserved.