Improving Documentation and Coding for Acute Organ Dysfunction Biases Severe Sepsis Surveillance Over Time

Sepsis is the presence of a known or suspected infection and a systemic inflammatory response. Severe sepsis is sepsis with acute organ dysfunction. Septic shock is a subset of severe sepsis characterized by systemic arterial hypotension or occult hypoperfusion. Severe sepsis is common, affecting more than 750 000 individuals in the United States each year with a hospital mortality of about 30%.Severe sepsis is a medical emergency that requires early identification, prompt evaluation, and treatment. The signs and symptoms of sepsis are influenced by the virulence of the pathogen, the portal of entry, the degree of organ dysfunction as well as the susceptibility and response of the host.

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Objective Sepsis Surveillance Using Electronic Clinical Data

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.264 ◽

2015 ◽

Vol 37 (2) ◽

pp. 163-171 ◽

Cited By ~ 34

Author(s):

Chanu Rhee ◽

Sameer Kadri ◽

Susan S. Huang ◽

Michael V. Murphy ◽

Lingling Li ◽

...

Keyword(s):

Severe Sepsis ◽

Electronic Health Record ◽

Organ Dysfunction ◽

Clinical Data ◽

Health Record ◽

Mortality Trends ◽

Incidence And Mortality ◽

Clinical Surveillance ◽

Electronic Health ◽

Over Time

OBJECTIVETo compare the accuracy of surveillance of severe sepsis using electronic health record clinical data vs claims and to compare incidence and mortality trends using both methods.DESIGNWe created an electronic health record–based surveillance definition for severe sepsis using clinical indicators of infection (blood culture and antibiotic orders) and concurrent organ dysfunction (vasopressors, mechanical ventilation, and/or abnormal laboratory values). We reviewed 1,000 randomly selected medical charts to characterize the definition’s accuracy and stability over time compared with a claims-based definition requiring infection and organ dysfunction codes. We compared incidence and mortality trends from 2003–2012 using both methods.SETTINGTwo US academic hospitals.PATIENTSAdult inpatients.RESULTSThe electronic health record–based clinical surveillance definition had stable and high sensitivity over time (77% in 2003–2009 vs 80% in 2012, P=.58) whereas the sensitivity of claims increased (52% in 2003–2009 vs 67% in 2012, P=.02). Positive predictive values for claims and clinical surveillance definitions were comparable (55% vs 53%, P=.65) and stable over time. From 2003 to 2012, severe sepsis incidence imputed from claims rose by 72% (95% CI, 57%–88%) and absolute mortality declined by 5.4% (95% CI, 4.6%–6.7%). In contrast, incidence using the clinical surveillance definition increased by 7.7% (95% CI, −1.1% to 17%) and mortality declined by 1.7% (95% CI, 1.1%–2.3%).CONCLUSIONSSepsis surveillance using clinical data is more sensitive and more stable over time compared with claims and can be done electronically. This may enable more reliable estimates of sepsis burden and trends.Infect. Control Hosp. Epidemiol. 2016;37(2):163–171

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Infection Plus Acute Organ Dysfunction Does Not Equal Severe Sepsis: An Examination Of Current Coding Practice

10.1164/ajrccm-conference.2011.183.1_meetingabstracts.a3859 ◽

2011 ◽

Author(s):

Walter T. Linde-Zwirble ◽

Yoonhee Choe ◽

Andrew F. Shorr

Keyword(s):

Severe Sepsis ◽

Organ Dysfunction ◽

Acute Organ Dysfunction

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Infection Rate and Acute Organ Dysfunction Risk as Explanations for Racial Differences in Severe Sepsis

JAMA ◽

10.1001/jama.2010.851 ◽

2010 ◽

Vol 303 (24) ◽

pp. 2495 ◽

Cited By ~ 135

Author(s):

Florian B. Mayr

Keyword(s):

Severe Sepsis ◽

Racial Differences ◽

Organ Dysfunction ◽

Infection Rate ◽

Acute Organ Dysfunction

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Association of weekend effect with early mortality in severe sepsis patients over time

Journal of Infection ◽

10.1016/j.jinf.2016.12.009 ◽

2017 ◽

Vol 74 (4) ◽

pp. 345-351 ◽

Cited By ~ 12

Author(s):

Yu-Ning Shih ◽

Yung-Tai Chen ◽

Chia-Jen Shih ◽

Shuo-Ming Ou ◽

Yen-Tao Hsu ◽

...

Keyword(s):

Severe Sepsis ◽

Early Mortality ◽

Weekend Effect ◽

Over Time

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Trends in the incidence and outcome of sepsis using data from a Japanese nationwide medical claims database-the Japan Sepsis Alliance (JaSA) study group-

Critical Care ◽

10.1186/s13054-021-03762-8 ◽

2021 ◽

Vol 25 (1) ◽

Author(s):

Taro Imaeda ◽

Taka-aki Nakada ◽

Nozomi Takahashi ◽

Yasuo Yamao ◽

Satoshi Nakagawa ◽

...

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Hospital Stay ◽

Organ Dysfunction ◽

Length Of Hospital Stay ◽

Annual Incidence ◽

Claim Database ◽

Antibiotic Administration ◽

Electronic Health Record Data ◽

Acute Organ Dysfunction

Abstract Background Trends in the incidence and outcomes of sepsis using a Japanese nationwide database were investigated. Methods This was a retrospective cohort study. Adult patients, who had both presumed serious infections and acute organ dysfunction, between 2010 and 2017 were extracted using a combined method of administrative and electronic health record data from the Japanese nationwide medical claim database, which covered 71.5% of all acute care hospitals in 2017. Presumed serious infection was defined using blood culture test records and antibiotic administration. Acute organ dysfunction was defined using records of diagnosis according to the international statistical classification of diseases and related health problems, 10th revision, and records of organ support. The primary outcomes were the annual incidence of sepsis and death in sepsis per 1000 inpatients. The secondary outcomes were in-hospital mortality rate and length of hospital stay in patients with sepsis. Results The analyzed dataset included 50,490,128 adult inpatients admitted between 2010 and 2017. Of these, 2,043,073 (4.0%) patients had sepsis. During the 8-year period, the annual proportion of patients with sepsis across inpatients significantly increased (slope = + 0.30%/year, P < 0.0001), accounting for 4.9% of the total inpatients in 2017. The annual death rate of sepsis per 1000 inpatients significantly increased (slope = + 1.8/1000 inpatients year, P = 0.0001), accounting for 7.8 deaths per 1000 inpatients in 2017. The in-hospital mortality rate and median (interquartile range) length of hospital stay significantly decreased (P < 0.001) over the study period and were 18.3% and 27 (15–50) days in 2017, respectively. Conclusions The Japanese nationwide data indicate that the annual incidence of sepsis and death in inpatients with sepsis significantly increased; however, the annual mortality rates and length of hospital stay in patients with sepsis significantly decreased. The increasing incidence of sepsis and death in sepsis appear to be a significant and ongoing issue.

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