Document Detail

Severe sepsis cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population.
MedLine Citation:
PMID:  23385099     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: The epidemiology of severe sepsis is derived from administrative databases that rely on International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes to select cases. We compared the sensitivity of two code abstraction methods in identifying severe sepsis cases using a severe sepsis registry.
DESIGN: Single-center retrospective cohort study.
SETTING: Tertiary care, Academic, University Hospital.
PATIENTS: One thousand seven hundred thirty-five patients with severe sepsis or septic shock.
MEASUREMENTS: Proportion identified as severe sepsis using two code abstraction methods: 1) the new specific ICD-9 codes for severe sepsis and septic shock, and 2) a validated method requiring two ICD-9 codes for infection and end-organ dysfunction. Multivariable logistic regression was performed to determine sociodemographics and clinical characteristics associated with documentation and coding accuracy.
MAIN RESULTS: The strategy combining a code for infection and end-organ dysfunction was more sensitive in identifying cases than the method requiring specific ICD-9 codes for severe sepsis or septic shock (47% vs. 21%). Elevated serum lactate level (p<0.001), ICU admission (p<0.001), presence of shock (p<0.001), bacteremia as the source of sepsis (p=0.02), and increased Acute Physiology and Chronic Health Evaluation II score (p<0.001) were independently associated with being appropriately documented and coded. The 28-day mortality was significantly higher in those who were accurately documented/coded (41%, compared with 14% in those who were not, p<0.001), reflective of a more severe presentation on admission.
CONCLUSIONS: Patients admitted with severe sepsis and septic shock were incompletely documented and under-coded, using either ICD-9 code abstracting method. Documentation of subsequent coding of severe sepsis was more common in more severely ill patients. These findings are important when evaluating current national estimates and when interpreting epidemiologic studies of severe sepsis as cohorts derived from claims-based strategies appear to be biased toward a more severely ill patient population.
Stacey-Ann Whittaker; Mark E Mikkelsen; David F Gaieski; Sherine Koshy; Craig Kean; Barry D Fuchs
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  41     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-03-26     Completed Date:  2013-05-30     Revised Date:  2014-04-02    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  945-53     Citation Subset:  AIM; IM    
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MeSH Terms
Abstracting and Indexing as Topic / methods*
Cohort Studies
Critical Illness / classification*,  epidemiology*
Hospitals, University
Intensive Care
International Classification of Diseases
Medical Records / statistics & numerical data
Middle Aged
Retrospective Studies
Risk Assessment
Sensitivity and Specificity
Sepsis / classification*,  diagnosis,  epidemiology*
Severity of Illness Index*
Shock, Septic / classification,  epidemiology
Grant Support
Comment In:
Crit Care Med. 2013 Apr;41(4):1134-6   [PMID:  23528757 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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