Comparison of International Classification of Disease-Ninth Revision (ICD-9) Coding with Retrospective Case Review for the Diagnosis of Septic Shock.

Poulose, JT; Cartin‐Ceba, Rodrigo; Shoja, A; Trillo-Alvarez, CA; Kashyap, Rahul; Patch, Richard K.; Poulose, L; Cabello-Graza, J; Li, G; Shari, G; Cabanela, Rosa L.; Naessens, James M.; Gajić, Ognjen; Seferian, Edward G.

doi:10.1164/ajrccm-conference.2009.179.1_meetingabstracts.a4691

Cited by 9 publications

(11 citation statements)

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“…First, our study was designed to test the sensitivity of two claims-based strategies to identify severe sepsis. Our study design does not permit us to comment on other test characteristics of these strategies; however, our approach is reasonable given recent studies which suggest that specificity approaches 100% (9–10). In addition, since our search strategy requires the presence of two or more systemic inflammatory response syndrome (SIRS) criteria, we may have underestimated the number of patients with severe sepsis admitted from the ED during the study period.…”

Section: Discussionmentioning

confidence: 99%

“…Based on observations of physician documentation in chart reviews done at our institution, and suggestions from recent, small validation studies (9–10), we hypothesized that severe sepsis and septic shock would be inadequately documented and therefore under-coded. As recent studies suggested that specificity approaches 100% with the new criteria-specific ICD-9 codes (9–10), we focused our study on the sensitivity of these two different coding strategies.…”

Section: Introductionmentioning

confidence: 99%

“…As recent studies suggested that specificity approaches 100% with the new criteria-specific ICD-9 codes (9–10), we focused our study on the sensitivity of these two different coding strategies. Because important, recent studies have relied on claims-based definitions of severe sepsis (10–12), it is critical to understand the limitations of these approaches to inform our understanding of the epidemiology of severe sepsis and to aid in our interpretation of studies which rely on such approaches.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Severe Sepsis Cohorts Derived From Claims-Based Strategies Appear to be Biased Toward a More Severely Ill Patient Population*

Whittaker

Mikkelsen

Gaieski

et al. 2013

Critical Care Medicine

143

126

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Objective The epidemiology of severe sepsis is derived from administrative databases that rely on 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 1735 patients with severe sepsis or septic shock Interventions None 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 APACHE 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 to 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 severe sepsis using the new sepsis codes 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 towards a more severely ill patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Severe Sepsis Cohorts Derived From Claims-Based Strategies Appear to be Biased Toward a More Severely Ill Patient Population*

Whittaker

Mikkelsen

Gaieski

et al. 2013

Critical Care Medicine

143

126

View full text Add to dashboard Cite

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“…The present on admission modifier allows for discrimination of pre-existing diagnoses from complications occurring after hospital admission (19–21). We included patients with a diagnosis of septic shock present on admission ( ICD-9-CM code 785.52; sensitivity approximately 45% and specificity 99%) (22, 23). …”

Section: Methodsmentioning

confidence: 99%

Do-Not-Resuscitate Status and Observational Comparative Effectiveness Research in Patients With Septic Shock*

Bradford

Lindenauer

Wiener

et al. 2014

Critical Care Medicine

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Objectives To assess the importance of including Do Not Resuscitate (DNR) status in critical care observational comparative effectiveness research. Design Retrospective analysis Setting All California hospitals participating in the 2007 California State Inpatient Database – which provides DNR status within the first 24 hours of admission. Patients Septic shock present on admission. Interventions None Measurements We investigated the association of early DNR status with in-hospital mortality among patients with septic shock. We also examined the strength of confounding of DNR status on the association between activated protein C therapy and mortality, an association with conflicting results between observational and randomized studies. Main Results We identified 24,408 patients with septic shock; 19.6% had a DNR order. Compared to patients without a DNR order, those with a DNR order were significantly more likely to be older (75±14 vs. 67±16 years), white race (62% vs. 53%), with more acute organ failures (1.44±1.15 vs. 1.38±1.15), but fewer in-patient interventions (1.0±1.0 vs. 1.4±1.1). Adding DNR status to a model with 46 covariates improved mortality discrimination (c-statistic 0.73 to 0.76, p<0.001). Addition of DNR status to a multivariable model assessing the association between activated protein C and mortality resulted in an 8% shift in the activated protein C effect estimate towards the null [odds ratio 0.78; (95% CI 0.61–0.99), p=0.04 to 0.85 (0.67–1.08), p=0.19]. Conclusions Among patients with septic shock, DNR status acts as a strong confounder that may inform past discrepancies between observational and randomized studies of activated protein C. Inclusion of early DNR status into more administrative databases may improve observational comparative effectiveness methodology.

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“…As a proxy for intensive care, we performed a subgroup analysis in patients with claims for mechanical ventilation. 23 Previous studies have demonstrated 95% sensitivity and 99% specificity for AF ICD-9-CM 427.3× claims. 13 We validated present on admission modifiers (see eSupplement) for severe sepsis and AF claims; agreement between severe sepsis present on admission status and blinded chart review was 91% (kappa 0.77) and an agreement between AF present on admission status and blinded chart review was 90% (kappa 0.74), similar to previous findings.…”

Section: Sensitivity Analysesmentioning

confidence: 96%

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

Walkey¹,

Wiener²,

Ghobrial³

et al. 2012

Survey of Anesthesiology

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Context-New-onset fibrillation (AF) has been reported in 6-20% of patients with severe sepsis. Whereas chronic AF is a known risk factor for stroke and death, the clinical significance of newonset AF in the setting of severe sepsis is uncertain.Objective-To determine the in-hospital stroke and in-hospital mortality risks associated with new-onset AF in patients with severe sepsis. Conclusion-Among patients with severe sepsis, patients with new-onset AF were at increased risk for in-hospital stroke and death compared with patients with no AF and patients with preexisting AF. Design-Retrospective

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Comparison of International Classification of Disease-Ninth Revision (ICD-9) Coding with Retrospective Case Review for the Diagnosis of Septic Shock.

Cited by 9 publications

References 0 publications

Severe Sepsis Cohorts Derived From Claims-Based Strategies Appear to be Biased Toward a More Severely Ill Patient Population*

Severe Sepsis Cohorts Derived From Claims-Based Strategies Appear to be Biased Toward a More Severely Ill Patient Population*

Do-Not-Resuscitate Status and Observational Comparative Effectiveness Research in Patients With Septic Shock*

Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe Sepsis

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