Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis

BMC Anesthesiology

Research Article

Sandra McCormick¹  Victoria J. Fraser²  David K. Warren²  S. Reza Jafarzadeh²  Jonas Marschall³  Benjamin S. Thomas⁴ 

[1] Center for Clinical Excellence, BJC HealthCare, 4901 Forest Park Avenue, 63108, St. Louis, MO, USA;Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, 63110, St. Louis, MO, USA;Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, 63110, St. Louis, MO, USA;Department of Infectious Diseases, Bern University Hospital and University of Bern, Friedbühlstrasse 51, CH-3010, Bern, Switzerland;Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, Campus Box 8051, 660 South Euclid Avenue, 63110, St. Louis, MO, USA;Department of Medicine, John A. Burns School of Medicine, 651 Ilalo Street, 96813, Honolulu, HI, USA;

关键词: Severe Sepsis;    Systemic Inflammatory Response Syndrome;    Annual Percentage Change;    Survive Sepsis Campaign;    Administrative Claim Data;   

DOI  :  10.1186/s12871-015-0148-z

 received in 2015-03-25, accepted in 2015-11-11,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundRecent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear.MethodsWe performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri. Temporal-trend and annual percent change were estimated using regression models with autoregressive integrated moving average errors.ResultsWe analyzed 62,261 inpatient admissions during the 5-year study period. ‘Any SIRS’ (i.e., SIRS on a single calendar day during the hospitalization) and ‘multi-day SIRS’ (i.e., SIRS on 3 or more calendar days), which both use patient-level data, and medical coding for sepsis (i.e., ICD-9-CM discharge diagnosis codes 995.91, 995.92, or 785.52) were present in 35.3 %, 17.3 %, and 3.3 % of admissions, respectively. The incidence of admissions coded for sepsis increased 9.7 % (95 % CI: 6.1, 13.4) per year, while the patient data-defined events of ‘any SIRS’ decreased by 1.8 % (95 % CI: −3.2, −0.5) and ‘multi-day SIRS’ did not change significantly over the study period. Clinically-defined sepsis (defined as SIRS plus bacteremia) and severe sepsis (defined as SIRS plus hypotension and bacteremia) decreased at statistically significant rates of 5.7 % (95 % CI: −9.0, −2.4) and 8.6 % (95 % CI: −4.4, −12.6) annually. All-cause mortality, SIRS mortality, and SIRS and clinically-defined sepsis case fatality did not change significantly during the study period. Sepsis mortality, based on ICD-9-CM codes, however, increased by 8.8 % (95 % CI: 1.9, 16.2) annually.ConclusionsThe incidence of sepsis, defined by ICD-9-CM codes, and sepsis mortality increased steadily without a concomitant increase in SIRS or clinically-defined sepsis. Our results highlight the need to develop strategies to integrate clinical patient-level data with administrative data to draw more accurate conclusions about the epidemiology of sepsis.

【 授权许可】

CC BY   
© Thomas et al. 2015