Comparison of Trends in Sepsis Incidence and Coding Using Administrative Claims Versus Objective Clinical Data

Abstract

The incidence of hospitalizations with sepsis codes rose dramatically while hospitalizations with corresponding objective clinical markers remained stable or decreased. Coding for sepsis has become more inclusive, and septicemia diagnoses are increasingly being applied to patients without positive blood cultures. These changes likely explain some of the apparent rise in sepsis incidence and underscore the need for more reliable surveillance methods.

Global Epidemiology of Pediatric Severe Sepsis: The Sepsis Prevalence, Outcomes, and Therapies Study

“…The hospital mortality rate of 25% confirms that severe sepsis remains a critical public 23 (12-28) 20 (5-26) 21 25 (19-28) 26 (20-28) 25 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 22 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) ,0.001…”

“…Vasoactive medications were used in 55%, with significant variation across age groups (P = 0.01) and the highest use in infants aged 29 days to 1 year (see Table E3). Vasoactive medications were used for a median of 7 (IQR,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) days. Epinephrine and norepinephrine were the most commonly used medications, at 43% and 42% of patients treated with vasoactive medications, respectively, and dopamine was used in 32%.…”

“…Hospital mortality was 25% and did not differ by age or between developed and resourcelimited countries. Median ventilator-free days were 16 (IQR, 0-25), and vasoactive-free days were 23 (IQR,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Sixty-seven percent of patients had multiorgan dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multiorgan dysfunction.…”

“…Recent reports of a rising prevalence of pediatric sepsis (1,6,7) may reflect an expanding vulnerable population with chronic comorbidities (8,9), increasing rates of multidrug-resistant organisms and opportunistic infections (10,11), and a surge in sepsis surveillance (12,13). However, shifting patterns of diagnostic coding may confound current epidemiological estimates that are based largely on retrospectively identified cases in administrative databases (5,14), and prior studies using prospective case identification have been limited to few sites within single countries, thus precluding broad generalizations (2,5,15). To date, no pediatric studies have examined the epidemiology and global burden of severe sepsis across multiple countries using a prospective methodology.…”

Variation in the Contents of Sepsis Bundles and Quality Measures: A Systematic Review

“…Sepsis, the body's inflammatory response to severe infection, contributes to one in every two to three inpatient hospital deaths, and the incidence appears to be increasing (1)(2)(3). In 2011, aggregate hospital costs for sepsis hospitalizations totaled more than $20 billion; the National Center for Health Statistics deemed it the most expensive condition treated in hospitals in the United States (4,5).…”