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Benchmarking the incidence and mortality of severe sepsis in the United States.
Crit Care Med. 2013 May; 41(5):1167-74.CC

Abstract

BACKGROUND

In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates.

OBJECTIVES

We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality.

DESIGN, SETTING, PARTICIPANTS

Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods.

MEASUREMENTS

Annual national incidence and in-hospital mortality of severe sepsis.

RESULTS

The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]).

CONCLUSION

There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions.

Authors+Show Affiliations

Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. gaieskid@uphs.upenn.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23442987

Citation

Gaieski, David F., et al. "Benchmarking the Incidence and Mortality of Severe Sepsis in the United States." Critical Care Medicine, vol. 41, no. 5, 2013, pp. 1167-74.
Gaieski DF, Edwards JM, Kallan MJ, et al. Benchmarking the incidence and mortality of severe sepsis in the United States. Crit Care Med. 2013;41(5):1167-74.
Gaieski, D. F., Edwards, J. M., Kallan, M. J., & Carr, B. G. (2013). Benchmarking the incidence and mortality of severe sepsis in the United States. Critical Care Medicine, 41(5), 1167-74. https://doi.org/10.1097/CCM.0b013e31827c09f8
Gaieski DF, et al. Benchmarking the Incidence and Mortality of Severe Sepsis in the United States. Crit Care Med. 2013;41(5):1167-74. PubMed PMID: 23442987.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Benchmarking the incidence and mortality of severe sepsis in the United States. AU - Gaieski,David F, AU - Edwards,J Matthew, AU - Kallan,Michael J, AU - Carr,Brendan G, PY - 2013/2/28/entrez PY - 2013/2/28/pubmed PY - 2013/6/21/medline SP - 1167 EP - 74 JF - Critical care medicine JO - Crit Care Med VL - 41 IS - 5 N2 - BACKGROUND: In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates. OBJECTIVES: We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality. DESIGN, SETTING, PARTICIPANTS: Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods. MEASUREMENTS: Annual national incidence and in-hospital mortality of severe sepsis. RESULTS: The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]). CONCLUSION: There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/23442987/Benchmarking_the_incidence_and_mortality_of_severe_sepsis_in_the_United_States_ L2 - https://dx.doi.org/10.1097/CCM.0b013e31827c09f8 DB - PRIME DP - Unbound Medicine ER -