TY - JOUR
T1 - Emergency department charges may be associated with mortality in patients with severe sepsis and septic shock
T2 - A cohort study
AU - Mohr, Nicholas M.
AU - Dick-Perez, Ryan
AU - Ahmed, Azeemuddin
AU - Harland, Karisa K.
AU - Shane, Dan
AU - Miller, Daniel
AU - Miyake, Christine
AU - Kannedy, Levi
AU - Fuller, Brian M.
AU - Torner, James C.
N1 - Funding Information:
This project is supported by the Emergency Medicine Foundation, the University of Iowa Department of Emergency Medicine, and the University of Iowa Institute for Clinical and Translational Sciences, which is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant U54TR001356. The organizations funding this research did not have any access to data or contribute to the study design or interpretation. The funding organization played no role in the acquisition, analysis, or reporting of this research report. Dr. Mohr is also supported by a grant from the Federal Office of Rural Health Policy. Dr. Fuller was funded by the Washington University KL2 Career Development Award and (KL2 TR000450) from the National Center for Advancing Translational Sciences (NCATS) and the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041–88).
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/12/29
Y1 - 2018/12/29
N2 - Background: Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. We hypothesized that emergency department (ED) charges may be associated with hospital mortality, and could be a surrogate marker of severity of illness for research purposes. The objective of this study was to measure concordance between ED charges and mortality in admitted patients with severe sepsis or septic shock. Methods: Cohort study of all adult patients presenting to a 60,000-visit Midwestern academic ED with severe sepsis or septic shock (by ICD-9 codes) between July 1, 2008 and June 30, 2010. Data on demographics, admission APACHE-II score, and disposition was extracted from the medical record, and comorbidities were identified from diagnosis codes using the Elixhauser methodology. Summary statistics were reported and bivariate concordance was tested using Pearson correlation. Logistic regression models for 28-day mortality were developed to measure the independent association with mortality. Results: We included a total of 294 patients in the analysis. We found that ED charges were inversely related to mortality (adjusted OR 0.829 per $1000 increase in total ED charges, 95%CI 0.702-0.980). ED charges were also independently associated with 28-day hospital-free and ICU-free days (0.74 days increase per $1000 additional ED charges, 95%CI 0.06-1.41 and 0.81 days increase per $1000 additional ED charges, 95%CI 0.05-1.56, respectively). ED charges were also associated with APACHE-II score ($34 total ED charges per point increase in APACHE-II score, 95%CI $6-62). Conclusions: ED charges in administrative data sets are associated with in-hospital mortality and health care utilization, likely related to both illness severity and intensity of early sepsis resuscitation. ED charges may have a role in risk adjustment models using administrative data for acute care research.
AB - Background: Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. We hypothesized that emergency department (ED) charges may be associated with hospital mortality, and could be a surrogate marker of severity of illness for research purposes. The objective of this study was to measure concordance between ED charges and mortality in admitted patients with severe sepsis or septic shock. Methods: Cohort study of all adult patients presenting to a 60,000-visit Midwestern academic ED with severe sepsis or septic shock (by ICD-9 codes) between July 1, 2008 and June 30, 2010. Data on demographics, admission APACHE-II score, and disposition was extracted from the medical record, and comorbidities were identified from diagnosis codes using the Elixhauser methodology. Summary statistics were reported and bivariate concordance was tested using Pearson correlation. Logistic regression models for 28-day mortality were developed to measure the independent association with mortality. Results: We included a total of 294 patients in the analysis. We found that ED charges were inversely related to mortality (adjusted OR 0.829 per $1000 increase in total ED charges, 95%CI 0.702-0.980). ED charges were also independently associated with 28-day hospital-free and ICU-free days (0.74 days increase per $1000 additional ED charges, 95%CI 0.06-1.41 and 0.81 days increase per $1000 additional ED charges, 95%CI 0.05-1.56, respectively). ED charges were also associated with APACHE-II score ($34 total ED charges per point increase in APACHE-II score, 95%CI $6-62). Conclusions: ED charges in administrative data sets are associated with in-hospital mortality and health care utilization, likely related to both illness severity and intensity of early sepsis resuscitation. ED charges may have a role in risk adjustment models using administrative data for acute care research.
KW - Costs and cost analysis
KW - Critical illness
KW - Emergency service, hospital
KW - Health services research
KW - Risk adjustment
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=85059260160&partnerID=8YFLogxK
U2 - 10.1186/s12873-018-0212-3
DO - 10.1186/s12873-018-0212-3
M3 - Article
C2 - 30594140
AN - SCOPUS:85059260160
SN - 1471-227X
VL - 18
JO - BMC Emergency Medicine
JF - BMC Emergency Medicine
IS - 1
M1 - 62
ER -