{"doi":"10.1093/ofid/ofad336","title":"An Adjudication Protocol for Severe Pneumonia","abstract":"Background: Clinical end points that constitute successful treatment in severe pneumonia are difficult to ascertain and vulnerable to bias. The utility of a protocolized adjudication procedure to determine meaningful end points in severe pneumonia has not been well described. Methods: This was a single-center prospective cohort study of patients with severe pneumonia admitted to the medical intensive care unit. The objective was to develop an adjudication protocol for severe bacterial and/or viral pneumonia. Each episode of pneumonia was independently reviewed by 2 pulmonary and critical care physicians. If a discrepancy occurred between the 2 adjudicators, a third adjudicator reviewed the case. If a discrepancy remained after all 3 adjudications, consensus was achieved through committee review. Results: Evaluation of 784 pneumonia episodes during 593 hospitalizations achieved only 48.1% interobserver agreement between the first 2 adjudicators and 78.8% when agreement was defined as concordance between 2 of 3 adjudicators. Multiple episodes of pneumonia and presence of bacterial/viral coinfection in the initial pneumonia episode were associated with lower interobserver agreement. For an initial episode of bacterial pneumonia, patients with an adjudicated day 7-8 clinical impression of cure (compared with alternative impressions) were more likely to be discharged alive (odds ratio, 6.3; 95% CI, 3.5-11.6). Conclusions: A comprehensive adjudication protocol to identify clinical end points in severe pneumonia resulted in only moderate interobserver agreement. An adjudicated end point of clinical cure by day 7-8 was associated with more favorable hospital discharge dispositions, suggesting that clinical cure by day 7-8 may be a valid end point to use in adjudication protocols.","journal":"Open Forum Infectious Diseases","year":2023,"id":324700,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":33,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9635,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":560525,"name":"Catherine A. Gao","orcid":"0000-0001-5576-3943","position":1,"is_corresponding":false},{"id":707620,"name":"Justin Bodner","orcid":"0000-0001-7369-7724","position":2,"is_corresponding":false},{"id":266698,"name":"James M. Walter","orcid":"0000-0001-7428-3101","position":3,"is_corresponding":false},{"id":553697,"name":"Jacqueline M. Kruser","orcid":"0000-0003-3258-1869","position":4,"is_corresponding":false},{"id":470112,"name":"Helen K. Donnelly","orcid":"0000-0001-8827-8581","position":5,"is_corresponding":false},{"id":553692,"name":"Alvaro Donayre","orcid":"0000-0003-1877-0655","position":6,"is_corresponding":false},{"id":997593,"name":"Katie Clepp","orcid":"0000-0002-8197-5103","position":7,"is_corresponding":false},{"id":553694,"name":"Nicole Borkowski","orcid":"0000-0001-8650-6456","position":8,"is_corresponding":false},{"id":266702,"name":"Richard G. Wunderink","orcid":"0000-0002-8527-4195","position":9,"is_corresponding":false},{"id":267595,"name":"Benjamin D. Singer","orcid":"0000-0001-5775-8427","position":10,"is_corresponding":false},{"id":616779,"name":"The NU SCRIPT Study Investigators","orcid":null,"position":11,"is_corresponding":false},{"id":470110,"name":"Chiagozie I. Pickens","orcid":"0000-0002-3400-9228","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-19T01:08:16.809511Z","pmid":"37520413","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}