Detecting Adverse Events in Thai Hospitals Using Medical Record Reviews: Agreement among Reviewers
Pattapong Kessomboon, MD*, Supasit Panarunothai, MD**, Pradit Wongkanaratanakul, MD***
Affiliation : * Department of Community Medicine, Khon Kaen University, Khon Kaen ** Center for Health Equity Monitoring, Naresuan University, Phitsanulok *** National Health Security Office, Nonthaburi
Background : Attention to the problem of adverse events increases worldwide. The present study aimed to
evaluate inter-rater reliability of medical record reviews of adverse events in the Thai context.
Materials and Methods : A total of 279 inpatient records were reviewed by 23 clinical auditors. Each record
was examined independently by 3 auditors using a standardised review form. Agreements on the occurrence
of AEs among auditors were assessed using Kappa statistic (k).
Results : Agreement of the auditors in detecting at least 1 medical condition potentially related to AEs was
moderate (k = 0.54, 95% confidence interval (CI) 0.42-0.65). Agreement on each item of the listed conditions
ranged from slight to substantial (k = 0.08 to 0.79). There was a positive trend of the correlation between the
rate of the conditions and the kappa statistic (Spearman rank correlation = 0.65, p-value = 0.058). Agree-
ment on determining AEs occurrence was fair (weighted k = 0.34, CI = 0.22-0.45). Agreement on determining
AEs preventability was fair (weighted k = 0.27, CI = 0.16-0.39).
Conclusion : The reliability of medical record review to detect AEs is influenced by the prevalence rate of AEs,
as well as the variability among reviewers. The use of chart review to detect AE is reasonable if the rate of the
event is sufficiently high.
Keywords : Adverse event, Medical record review, Agreement
