Survey of New York City Resident Physicians on Cause-of-Death Reporting, 2010

Wexelman, Barbara; Eden, Edward; Rose, Keith

doi:10.5888/pcd10.120288

Cited by 54 publications

(50 citation statements)

References 10 publications

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“…For example, the New York City medical examiner's policy of rejecting New York City death certificates with sepsis listed alone as the single underlying cause of death (without other contributing causes) has been misinterpreted by some clinicians to mean that the term "sepsis" was not permitted to be included anywhere on the death certificate, thus affecting estimates of sepsis-related mortality (8). In addition, it is important to note that death certificates are often completed by physicians with varying levels of training in completing death certificates; data from a survey of resident physicians in New York City showed that only 40% reported receiving any training by their residency program regarding completion of death certificates (9). Finally, sepsis can be confused with other acute medical problems, such as myocardial infarction, that frequently cause mortality in the community setting.…”

Section: Discussionmentioning

confidence: 99%

Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes — United States, 1999–2014

Epstein

Dantes

Magill

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

120

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the largest all-payer, publicly-available inpatient database in the United States, using various combinations of the International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) administrative codes for primary or secondary infection and organ dysfunction to identify severe sepsis.In a published report (2), investigators generated a range of sepsis mortality estimates using four previously established approaches to identifying adult patients (aged ≥18 years) with sepsis using administrative claims data. Two of these approaches (4,5) defined sepsis using explicit, sepsis-specific ICD-9-CM codes in addition to various codes for infection and organ dysfunction, whereas the other two approaches (6,7) defined sepsis on the basis of combinations of infection criteria and organ dysfunction as implicit markers for severe sepsis.Multiple cause-of-death mortality files maintained in the CDC WONDER database were reviewed to analyze deaths (for all ages) from sepsis reported on death certificates during 1999-2014, defined as deaths with diagnoses corresponding to International Classification of Diseases 10th Revision (ICD-10) diagnosis codes A40 (streptococcal septicemia) and A41 (other septicemia) listed on the death certificate. The annual sepsis mortality estimates based on death certificates from the WONDER database were then compared with the previously published annual estimates generated based on the ICD-9-CM administrative codes data from the Nationwide Inpatient Sample.Based on multiple cause-of-death data during 1999-2014, a total of 2,470,666 decedents (6% of all deaths) had sepsis listed among the causes of death (sepsis-related deaths); for 22% of these decedents, sepsis was listed as the underlying cause of death. During this period, the annual number of all reported sepsis-related deaths increased 31%, from 139,086 in 1999 to 182,242 in 2014 (Figure 1). Approximately 15% of all sepsis-related deaths during this period occurred in nonacute care settings (e.g., at home, long-term care facilities, hospice, and unknown setting). Among the 2,472,911 A40 and A41 codes listed for the 2,470,666 decedents, the most common were unspecified septicemia (A41.9, 94%), septicemia caused by other gram-negative organisms (A41.5, 2%), and septicemia caused by Staphylococcus aureus (A41.0, 2%). Among decedents, approximately 49% were aged 65-84 years, 26% were aged ≥85 years, and 25% were aged 25-64 years (4% aged Sepsis is a clinical syndrome caused by a dysregulated host response to infection (1). Because there is no confirmatory diagnostic test, the diagnosis of sepsis is based on evidence of infection and clinical judgement. Both death certificates and health services utilization data (administrative claims) have been used to assess sepsis incidence and mortality, but estimates vary depending on the surveillance definition and data source. To highlight the challenges and variability associated with estimating sepsis mortality, CDC compared national estimates of sepsis-related mortality based on dea...

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Section: Discussionmentioning

confidence: 99%

Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes — United States, 1999–2014

Epstein

Dantes

Magill

et al. 2016

MMWR Morb. Mortal. Wkly. Rep.

120

View full text Add to dashboard Cite

show abstract

“…Causes of death recorded on death certificates are notoriously inaccurate and do not have a standard format [12,13]. In one large study by Mayr et al [14], the reason for death was determined in 3700 critically ill patients, a minority of whom had been admitted with sepsis.…”

Section: Discussionmentioning

confidence: 99%

Reasons for death in patients with sepsis and septic shock

Moskowitz

Omar

Chase

et al. 2017

Journal of Critical Care

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Purpose sepsis has broad implications for both clinical care and interventional trial design. However, reasons for death in sepsis remain poorly understood. We sought to characterize reasons for in-hospital mortality in a population of patients with sepsis or septic shock. Materials and methods We performed a retrospective review of patients admitted to the intensive care unit with sepsis or septic shock who died during their index admission. Reasons for death were classified into 6 categories determined a priori by group consensus. Interrater reliability was calculated and Fleiss κ reported. The associations between selected patient characteristics (eg, serum lactate) and reason for death were also assessed. Results One hundred fifteen patients were included. Refractory shock (40%) and comorbid withdrawal of care (44%) were the most common reasons for death. Overall interrater agreement was substantial (κ = 0.61, P < .01). Lactate was higher in patients who died because of refractory shock as compared with those who died for other reasons (4.7 vs 2.8 mmol/L, P < .01). Conclusion In this retrospective cohort, refractory shock and comorbid withdrawal of care were the most common reasons for death. Following prospective validation, the classification methodology presented here may be useful in the design/interpretation of trials in sepsis.

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“…We did not examine cause of death as this is subject to significant misclassification in administrative databases (40, 41). We did not find any differences in infections or narcotic use that would explain the difference in mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Mortality Associated With Medical Therapy Versus Elective Colectomy in Ulcerative Colitis

Bewtra

Newcomb

et al. 2015

Ann Intern Med

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Background Ulcerative colitis (UC) can be treated with surgery or medications. Patients often must choose between long-term immunosuppressive therapy or total colectomy. It is uncertain if there is a mortality benefit to one of these treatment approaches. Objective To determine whether patients with advanced UC treated with elective colectomy have an improved survival compared to patients treated with medical therapy. Design Retrospective matched cohort study Setting 50-state Medicaid and beneficiaries (2000–2005), Medicare-beneficiaries (2006–2011) and dual-eligible individuals (2000–2011) Patients 830 UC patients pursuing elective colectomy surgery and 7,541 matched UC patients pursuing medical therapy. Measurements The primary outcome was time to death. Cox proportional hazard models were used to compare the survival of advanced UC patients treated with elective colectomy or medical therapy. The models controlled for significant comorbidities through matched and adjusted analysis. Results The mortality rates associated with elective surgery and medical therapy were 34 and 54 per 1,000 person-years, respectively. Elective colectomy was associated with improved survival compared to pursuing chronic medical therapy (adjusted HR 0.67, 95% CI 0.52–0.87) although not all results remained statistically significant in the sensitivity analyses. Post-hoc analysis by age group showed improved survival with surgery in patients 50 years and older with advanced UC (HR 0.60, 95% CI 0.45–0.79, age by treatment interaction p=0.032). Limitation Retrospective non-randomized analysis can be subject to residual confounding. The source cohort was derived from different databases across the study period. Sensitivity and secondary analyses had reduced statistical power. Conclusion Elective colectomy surgery appeared to be associated with an improved survival rate relative to medical therapy among patients 50 years and older with advanced UC.

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Survey of New York City Resident Physicians on Cause-of-Death Reporting, 2010

Cited by 54 publications

References 10 publications

Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes — United States, 1999–2014

Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes — United States, 1999–2014

Reasons for death in patients with sepsis and septic shock

Mortality Associated With Medical Therapy Versus Elective Colectomy in Ulcerative Colitis

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