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Table 3 Triggers given the first and second time of screening

From: The Harvard medical practice study trigger system performance in deceased patients

Triggers Description First time positive (N)1 Second time positive (N)a Percentage agreement (%) Kappa agreement (95%CI) McNemar’s test (p-value) PABAKb (95%CI) Bias index Prevalence index
Trigger 1 Unplanned readmissionc (within 3 months) after discharge from index admission 13 17 88 0.53 (0.30–0.76) 0.39 0.76 (0.58–0.88) − 0.04 − 0.7
Trigger 2 Hospital-incurred patient injury (temporarily or lasting) 8 4 90 0.12 (−0.17–0.41) 0.34 0.80 (0.63–0.90) 0.04 −0.88
Trigger 3 Adverse drug reaction 2 6 92 −0.03 (− 0.06–0.002) 0.29 0.84 (0.68–0.93) − 0.04 − 0.92
Trigger 4 Unplanned transfer to the ICU 15 18 93 0.75 (0.57–0.92) 0.45 0.86 (0.70–0.94) −0.03 − 0.67
Trigger 5 Unplanned return to the operating room 8 12 96 0.78 (0.59–0.99) 0.13 0.92 (0.78–0.98) −0.04 − 0.80
Trigger 6 Unplanned removal, injury or repair of an organ during surgery 5 6 95 0.52 (0.15–0.89) 1.00 0.90 (0.75–0.97) −0.01 −0.89
Trigger 7 Healthcare related infection or sepsis 20 22 88 0.64 (0.45–0.83) 0.77 0.76 (0.58–0.88) −0.02 − 0.58
Trigger 8 Other complications such as CVA/lung embolism/acute myocardial infarction/TIA 17 16 89 0.60 (0.38–0.81) 1.00 0.78 (0.60–0.89) 0.01 −0.67
Trigger 9 Development of neurological deficit which was not present on admission 5 7 92 0.29 (−0.06–0.65) 0.73 0.84 (0.68–0.93) −0.02 − 0.88
Trigger 10 (Initial) unexpected and/or sudden death, (no palliative care) 12 14 84 0.29 (0.03–0.55) 0.80 0.68 (0.49–0.81) −0.02 −0.74
Trigger 11 Cardiac or respiratory arrest 12 11 93 0.66 (0.42–0.89) 1.00 0.86 (0.70–0.94) 0.01 −0.77
Trigger 12d Injury related to abortion or delivery
Trigger 13 Dissatisfaction with care documented in the record 2 5 95 0.27 (−0.17–0.71) 0.38 0.90 (0.75–0.97) −0.03 − 0.93
Trigger 14 Documentation indicating a legal claim or complaint proceduree 0 2
Trigger 15 Other patient complication 5 27 72 0.04 (−0.10–0.189) 0.00 0.44 (0.23–0.62) −0.22 − 0.68
  1. aNegative is 100-N
  2. bPABAK: prevalence and bias adjusted kappa
  3. cA readmission was considered as unplanned if admission was through the emergency department
  4. dThis trigger was not found in both rounds of the medical record analysis
  5. eNo statistics could be computed because trigger 14 is not present in the first round