Journal
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
Volume 318, Issue 13, Pages 1241-1249Publisher
AMER MEDICAL ASSOC
DOI: 10.1001/jama.2017.13836
Keywords
-
Categories
Funding
- Centers for Disease Control and Prevention [3U54CK000172-05S2]
- Agency for Healthcare Research and Quality [1K08H5025008-01A1]
- National Institutes of Health [R35GM119519]
- Department of Veterans Affairs [HSRD11-109]
- National Institutes of Health Clinical Center
- National Institute of Allergy and Infectious Diseases
Ask authors/readers for more resources
IMPORTANCE 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. OBJECTIVE To estimate the US national incidence of sepsis and trends using detailed clinical data from the electronic health record (EHR) systems of diverse hospitals. DESIGN, SETTING, AND POPULATION Retrospective cohort study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014. EXPOSURES 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. MAIN OUTCOMES AND MEASURES 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. RESULTS A total of 173 690 sepsis cases (mean age, 66.5 [SD, 15.5] y; 77 66@[42.4%] women) were identified using clinical criteria among 2 901 019 adults admitted to study hospitals in 2014 (6.0% incidence). Of these, 26 061(15.0%) died in the hospital and 10 731 (6.2%) were discharged to hospice. From 2009-2014, sepsis incidence using clinical criteria was stable (+0.6% relative change/y [95% CI, -2.3% to 3.5%]. P = .67) whereas incidence per claims increased (+10.3%/y [95% CI, 7.2% to 13.3%1 P <.001). In-hospital mortality using clinical criteria declined(-3.3%/y [95% CI, -5.6% to -1.0%], P = .004), but there was no significant change in the combined outcome of death or discharge to hospice (-1.3%/y [95% CI, -3.2% to 0.6%], P = .19). In contrast, mortality using claims declined significantly (-7.0%/y [95% CI, -8.8% to -5.2%]. P <.001), as did death or discharge to hospice (-4.5%/y [95% CI, -6]% to -2.8%1 P <.001). Clinical criteria were more sensitive in identifying sepsis than claims (69.7% [95% CI, 52.9% to 92.0%] vs 32.3% [95% CI, 24.4% to 43.0%]. P <.001), with comparable positive predictive value (70.4% [95% CI, 64.0% to 76.8%] vs 75.2% [95% CI, CONCLUSIONS AND RELEVANCE 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.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available