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Trends in sepsis and infection sources in the United States. A population-based study.
Ann Am Thorac Soc. 2015 Feb; 12(2):216-20.AA

Abstract

RATIONALE

Stakeholders seek to monitor processes and outcomes of care among patients with sepsis, but use of administrative data for sepsis surveillance is controversial. Prior studies using only principal diagnoses from claims data have shown a trend of rising sepsis incidence with falling infection incidence, implying that administrative data are inaccurate for sepsis surveillance.

OBJECTIVES

Because a sepsis diagnosis often modifies an infection site diagnosis, we sought to investigate trends in sepsis and infection using both principal and secondary diagnoses in administrative data.

METHODS

This was a retrospective cohort study. We used data from the Nationwide Inpatient Sample years 2003 to 2009 to identify age-standardized, population-based trends in sepsis and infection using all available diagnosis codes. Infection sites were defined as bacteremia, pneumonia, urinary tract, skin/soft tissue, and gastrointestinal; codes for septicemia, sepsis, severe sepsis, and septic shock were used to identify "sepsis." We identified patients with infection and mechanical ventilation to estimate incidence of severe sepsis without requiring specific claims for sepsis or acute organ failure.

MEASUREMENTS AND MAIN RESULTS

We identified 53.9 million adult infection hospitalizations during the years 2003 to 2009; average age was 63 years, 61% of patients were women, and 70% reported white race, 14% black, and 11% Hispanic ethnicity. Incidence of hospitalizations with an infection claim increased from 3,147/100,000 U.S. residents in 2003 to 3,480/100,000 in 2009 (11% increase), whereas hospitalizations with sepsis claims increased from 359/100,000 to 535/100,000 residents during the same time frame (49% increase); P = 0.009 between infection and sepsis trends. The proportion of infection hospitalizations with a sepsis claim increased from 7.5% in 2003 to 11.5% in 2009 (54% increase). The incidence of hospitalizations with both an infection and mechanical ventilation claim during 2003 was 173/100,000 as compared with 251/100,000 in 2009 (45% increase); P = 0.76 compared with sepsis trends.

CONCLUSIONS

Sepsis claims are increasing at a greater rate than infection claims but are not inversely related. Trends in sepsis are similar to trends in infection cases requiring mechanical ventilation. Further studies should seek to identify the optimal algorithms to identify sepsis within administrative data and explore potential mechanisms for the increasing incidence of infection and sepsis in the United States.

Authors+Show Affiliations

1 The Pulmonary Center, Department of Medicine, Division of Pulmonary, Allergy, and Critical Care Medicine, Boston University School of Medicine, Boston, Massachusetts.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25569845

Citation

Walkey, Allan J., et al. "Trends in Sepsis and Infection Sources in the United States. a Population-based Study." Annals of the American Thoracic Society, vol. 12, no. 2, 2015, pp. 216-20.
Walkey AJ, Lagu T, Lindenauer PK. Trends in sepsis and infection sources in the United States. A population-based study. Ann Am Thorac Soc. 2015;12(2):216-20.
Walkey, A. J., Lagu, T., & Lindenauer, P. K. (2015). Trends in sepsis and infection sources in the United States. A population-based study. Annals of the American Thoracic Society, 12(2), 216-20. https://doi.org/10.1513/AnnalsATS.201411-498BC
Walkey AJ, Lagu T, Lindenauer PK. Trends in Sepsis and Infection Sources in the United States. a Population-based Study. Ann Am Thorac Soc. 2015;12(2):216-20. PubMed PMID: 25569845.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Trends in sepsis and infection sources in the United States. A population-based study. AU - Walkey,Allan J, AU - Lagu,Tara, AU - Lindenauer,Peter K, PY - 2015/1/9/entrez PY - 2015/1/9/pubmed PY - 2015/11/18/medline KW - health services research KW - sepsis SP - 216 EP - 20 JF - Annals of the American Thoracic Society JO - Ann Am Thorac Soc VL - 12 IS - 2 N2 - RATIONALE: Stakeholders seek to monitor processes and outcomes of care among patients with sepsis, but use of administrative data for sepsis surveillance is controversial. Prior studies using only principal diagnoses from claims data have shown a trend of rising sepsis incidence with falling infection incidence, implying that administrative data are inaccurate for sepsis surveillance. OBJECTIVES: Because a sepsis diagnosis often modifies an infection site diagnosis, we sought to investigate trends in sepsis and infection using both principal and secondary diagnoses in administrative data. METHODS: This was a retrospective cohort study. We used data from the Nationwide Inpatient Sample years 2003 to 2009 to identify age-standardized, population-based trends in sepsis and infection using all available diagnosis codes. Infection sites were defined as bacteremia, pneumonia, urinary tract, skin/soft tissue, and gastrointestinal; codes for septicemia, sepsis, severe sepsis, and septic shock were used to identify "sepsis." We identified patients with infection and mechanical ventilation to estimate incidence of severe sepsis without requiring specific claims for sepsis or acute organ failure. MEASUREMENTS AND MAIN RESULTS: We identified 53.9 million adult infection hospitalizations during the years 2003 to 2009; average age was 63 years, 61% of patients were women, and 70% reported white race, 14% black, and 11% Hispanic ethnicity. Incidence of hospitalizations with an infection claim increased from 3,147/100,000 U.S. residents in 2003 to 3,480/100,000 in 2009 (11% increase), whereas hospitalizations with sepsis claims increased from 359/100,000 to 535/100,000 residents during the same time frame (49% increase); P = 0.009 between infection and sepsis trends. The proportion of infection hospitalizations with a sepsis claim increased from 7.5% in 2003 to 11.5% in 2009 (54% increase). The incidence of hospitalizations with both an infection and mechanical ventilation claim during 2003 was 173/100,000 as compared with 251/100,000 in 2009 (45% increase); P = 0.76 compared with sepsis trends. CONCLUSIONS: Sepsis claims are increasing at a greater rate than infection claims but are not inversely related. Trends in sepsis are similar to trends in infection cases requiring mechanical ventilation. Further studies should seek to identify the optimal algorithms to identify sepsis within administrative data and explore potential mechanisms for the increasing incidence of infection and sepsis in the United States. SN - 2325-6621 UR - https://www.unboundmedicine.com/medline/citation/25569845/Trends_in_sepsis_and_infection_sources_in_the_United_States__A_population_based_study_ L2 - https://www.atsjournals.org/doi/10.1513/AnnalsATS.201411-498BC?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -