COMPARISON OF CASE-FINDING METHODOLOGIES FOR ENDOMETRITIS AFTER CESAREAN-SECTION

Background: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity. However, traditional case-finding methods for endo metritis may not identify most cases. We compared various case-finding methods with a reference method to determine a simple and accurate me thod for collecting data on endometritis after cesarean section. Metho ds: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991. These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and a dmission and discharge diagnoses. Results: Each case-finding method wa s compared separately with the reference method (''gold standard''), w hich was designed to capture all cases among the patients in the study population (N = 145). This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures). The computerized report method linking patients who underwent cesarean section with antibiotic use h ad a positive predictive value of 0.53. Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively. Conclusions: In our institution, case fi nding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with IV antibiotic use da ta and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis. It also represents the most ef ficient use of the infection control department's resources.