TY - JOUR
T1 - Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis
AU - Thomas, Benjamin S.
AU - Jafarzadeh, S. Reza
AU - Warren, David K.
AU - McCormick, Sandra
AU - Fraser, Victoria J.
AU - Marschall, Jonas
N1 - Funding Information:
BST is supported by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR000448 from the National Center for Advancing Translational Sciences. JM, DKW, and VJF are supported by the Prevention Epicenters Program from the Centers for Disease Control and Prevention (U54 CK000162); JM was supported by the NIH NCATS KL2 program (UL1 RR024992, KL2 RR024994) and the Building Interdisciplinary Research Careers in Women’s Health (BIRCWH) award, a career development award (5K12HD001459-13). In addition, JM was the recipient of Barnes-Jewish Hospital Patient Safety and Quality Fellowship and received a research grant from the Barnes-Jewish Hospital Foundation and the Washington University’s Institute for Clinical and Translational Science. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or CDC. The funding sources listed above had no role in the writing of the manuscript or the decision to submit it for publication.
Publisher Copyright:
© 2015 Thomas et al.
PY - 2015/11/24
Y1 - 2015/11/24
N2 - Background: Recent 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. Methods: We 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. Results: We 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. Conclusions: The 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.
AB - Background: Recent 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. Methods: We 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. Results: We 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. Conclusions: The 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.
UR - http://www.scopus.com/inward/record.url?scp=84947780076&partnerID=8YFLogxK
U2 - 10.1186/s12871-015-0148-z
DO - 10.1186/s12871-015-0148-z
M3 - Article
C2 - 26597871
AN - SCOPUS:84947780076
VL - 15
JO - BMC Anesthesiology
JF - BMC Anesthesiology
SN - 1471-2253
IS - 1
M1 - 169
ER -