Prevalence and Clinical Characteristics of Patients With Sepsis Discharge Diagnosis Codes and Short Lengths of Stay in U.S. Hospitals

Abstract

Objectives: Some patients diagnosed with sepsis have very brief hospitalizations. Understanding the prevalence and clinical characteristics of these patients may provide insight into how sepsis diagnoses are being applied as well as the breadth of illnesses encompassed by current sepsis definitions. Design: Retrospective observational study. Setting: One-hundred ten U.S. hospitals in the Cerner HealthFacts dataset (primary cohort) and four hospitals in Eastern Massachusetts (secondary cohort used for detailed medical record reviews). Patients: Adults hospitalized from April 2016 to December 2017. Interventions: None. Measurements and Main Results: We identified hospitalizations with International Classification of Diseases, 10th Edition codes for sepsis (including sepsis, septicemia, severe sepsis, and septic shock) and compared “short stay sepsis” patients (defined as discharge alive within 3 d) versus nonshort stay sepsis patients using detailed electronic health record data. In the Cerner cohort, 67,733 patients had sepsis discharge diagnosis codes, including 6,918 (10.2%) with short stays. Compared with nonshort stay sepsis patients, short stay patients were younger (median age 60 vs 67 yr) and had fewer comorbidities (median Elixhauser score 5 vs 13), lower rates of positive blood cultures (8.2% vs 24.1%), lower rates of ICU admission (6.2% vs 31.6%), and less frequently had severe sepsis/septic shock codes (13.5% vs 36.6%). Almost all short stay and nonshort stay sepsis patients met systemic inflammatory response syndrome criteria at admission (84.5% and 87.5%, respectively); 47.2% of those with short stays had Sequential Organ Failure Assessment scores of 2 or greater at admission versus 73.2% of those with longer stays. Findings were similar in the secondary four-hospital cohort. Medical record reviews demonstrated that physicians commonly diagnosed sepsis based on the presence of systemic inflammatory response syndrome criteria, elevated lactates, or positive blood cultures without concurrent organ dysfunction. Conclusions: In this large U.S. cohort, one in 10 patients coded for sepsis were discharged alive within 3 days. Although most short stay patients met systemic inflammatory response syndrome criteria, they met Sepsis-3 criteria less than half the time. Our findings underscore the incomplete uptake of Sepsis-3 definitions, the breadth of illness severities encompassed by both traditional and new sepsis definitions, and the possibility that some patients with sepsis recover very rapidly.

A machine learning predictive model of in-hospital mortality in patients with sepsis complicated by anemia: a retrospective study based on the MIMIC-III database

“…The mortality of patients with sepsis is also positively correlated with age [32]. Therefore, it is clinically feasible to use the comorbidity index to determine the risk of mortality of patients with sepsis, consistent with other studies [33][34][35].…”

Elucidating the Spectrum of Disease Severity Encompassed by Sepsis

“…4 Another study reported that, among 67 733 patients with sepsis diagnosis who were admitted to 110 US hospitals, 1 in 10 were discharged alive within 3 days. 5 The analysis by Peltan and colleagues 3 expands on these studies by providing the clinical characteristics and 30-day outcomes of patients with sepsis who were discharged from the ED.…”

“…4 Another study reported that, among 67 733 patients with sepsis diagnosis who were admitted to 110 US hospitals, 1 in 10 were discharged alive within 3 days. 5 The analysis by Peltan and colleagues 3 expands on these studies by providing the clinical characteristics and 30-day outcomes of patients with sepsis who were discharged from the ED.These patients tended to be younger and less severely ill compared with those who were admitted to the hospital, with fewer perturbations in their vital signs, milder organ dysfunction, and higher rates of arrival by private vehicle over ambulance. Two-thirds had urinary infections, whereas those who were admitted to the hospital more commonly had pulmonary or intra-abdominal infections.The 30-day mortality rate in patients who were discharged was only 0.9% compared with 8.3% in those who were hospitalized.…”

“…A national study of ED visits between 2009 and 2011 that defined sepsis using diagnosis codes and/or clinical criteria reported that approximately 20% of patients with sepsis did not require inpatient admission . Another study reported that, among 67 733 patients with sepsis diagnosis who were admitted to 110 US hospitals, 1 in 10 were discharged alive within 3 days …”

A Systems Approach to Reducing Medical Error

“…However, I also believe they can inadvertently promote cognitive biases such as diagnostic anchoring and premature closure, thereby preempting consideration of alternate diagnoses. Proof of the negative impact of these diagnostic aids may be hard to come by, but many have expressed this concern . Furthermore, these diagnostic aids may pose a particular concern about their effect on the development of medical trainees’ clinical reasoning skills.…”