Self-Diagnosis of Surgical Site Infections: Lessons from a Tertiary Care Centre in Karachi, Pakistan

Abstract

Background and Objective: Surgical site infections (SSIs) usually manifest post-discharge, rendering accurate diagnosis and treatment challenging, thereby catalyzing the development of alternate strategies like self-monitored SSI surveillance. This study aims to evaluate the diagnostic accuracy of patients and Infection Control Monitors (ICMs) to develop a replicable method of SSI-detection.
 Methods: A two-year prospective diagnostic accuracy study was conducted in Karachi, Pakistan between 2015 and 2017. Patients were educated about SSIs and provided with questionnaires to elicit symptoms of SSI during post-discharge self-screening. Results of patient’s self-screening and ICM evaluation at follow-ups were compared to surgeon evaluation.
 Results: A total of 348 patients completed the study, among whom 18 (5.5%) developed a SSI. Patient self-screening had a sensitivity of 39%, specificity of 95%, positive predictive value (PPV) of 28%, and negative predictive value (NPV) of 97%. ICM evaluation had a sensitivity of 82%, specificity of 99%, PPV of 82%, and NPV of 99%.
 Conclusion: Patients cannot self-diagnose a SSI reliably. However, diagnostic accuracy of ICMs is significantly higher and they may serve as a proxy for surgeons, thereby reducing the burden on specialized surgical workforce in LMICs. Regardless, supplementing post-discharge follow-up with patient self-screening could increase SSI-detection and reduce burden on health systems.
 doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1716
 How to cite this:Sajun SZ, Albutt K, Moosajee US, Drevin G, Mukhopadhyay S, Samad L. Self-Diagnosis of Surgical Site Infections: Lessons from a tertiary care centre in Karachi, Pakistan. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S55-S60. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1716
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Do Patients Accurately Represent Their Experiences After Hip and Knee Replacements?

“…Previous studies have demonstrated a significant difference in the accuracy of patients reporting complications depending on the type of complication being reported [18][19][20]. Many studies have shown patients to be poor at self-diagnosing surgical site infections which may partly explain the low PPVs seen in category [21][22][23]. However, it is difficult to apply this theory of varying perceptions to the outcomes of readmission or reoperation which are clearer and more binary outcomes.…”