Estimates from claims-based analyses suggest that the incidence of sepsis is increasing and mortality rates from sepsis are decreasing. However, estimates from claims data may lack clinical fidelity and can be affected by changing diagnosis and coding practices over time.
Dr Chanu Rhee and colleagues estimated the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals.
The team performed a retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014.
|15% died in the hospital|
|Journal of the American Medical Association|
Sepsis was identified using clinical indicators of presumed infection and concurrent acute organ dysfunction, adapting Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria for objective and consistent EHR-based surveillance.
Sepsis incidence, outcomes, and trends from 2009-2014 were calculated using regression models and compared with claims-based estimates using International Classification of Diseases, Ninth Revision, Clinical Modification codes for severe sepsis or septic shock.
Case-finding criteria were validated against Sepsis-3 criteria using medical record reviews.
The research team identified a total of 173,690 sepsis cases using clinical criteria among 2,901,019 adults admitted to study hospitals in 2014.
Of these, the team observed that 15% died in the hospital, and 6% were discharged to hospice.
From 2009-2014, sepsis incidence using clinical criteria was stable whereas incidence per claims increased.
The researchers found that in-hospital mortality using clinical criteria declined, but there was no significant change in the combined outcome of death or discharge to hospice.
The team noted that mortality using claims declined significantly, as did death or discharge to hospice.
Clinical criteria were more sensitive in identifying sepsis than claims, with comparable positive predictive value.
Dr Rhee's team concludes, "In clinical data from 409 hospitals, sepsis was present in 6% of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014."
"The findings also suggest that EHR-based clinical data provide more objective estimates than claims-based data for sepsis surveillance."