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Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes.
J Pediatr. 2015 Dec; 167(6):1295-300.e4.JPed

Abstract

OBJECTIVES

To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard.

STUDY DESIGN

Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification.

RESULTS

A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008).

CONCLUSIONS

Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction.

Authors+Show Affiliations

Children's Hospital of Philadelphia, Philadelphia, PA.Children's Hospital of Philadelphia, Philadelphia, PA.Children's Hospital Association, Overland Park, KS.Boston Children's Hospital, Boston, MA.Children's Hospital Colorado, Aurora, CO.Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Wake Forest Baptist Medical Center, Wake Forest, NC.Children's Hospital Seattle, Seattle, WA.Nationwide Children's Hospital, Columbus, OH.Children's Hospital of Philadelphia, Philadelphia, PA.Children's Hospital Colorado, Aurora, CO.Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Children's Hospital of Philadelphia, Philadelphia, PA.Cincinnati Children's Hospital Medical Center, Cincinnati, OH.Lurie Children's Hospital of Chicago, Chicago, IL.

Pub Type(s)

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

Language

eng

PubMed ID

26470685

Citation

Balamuth, Fran, et al. "Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes." The Journal of Pediatrics, vol. 167, no. 6, 2015, pp. 1295-300.e4.
Balamuth F, Weiss SL, Hall M, et al. Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes. J Pediatr. 2015;167(6):1295-300.e4.
Balamuth, F., Weiss, S. L., Hall, M., Neuman, M. I., Scott, H., Brady, P. W., Paul, R., Farris, R. W., McClead, R., Centkowski, S., Baumer-Mouradian, S., Weiser, J., Hayes, K., Shah, S. S., & Alpern, E. R. (2015). Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes. The Journal of Pediatrics, 167(6), 1295-e4. https://doi.org/10.1016/j.jpeds.2015.09.027
Balamuth F, et al. Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes. J Pediatr. 2015;167(6):1295-300.e4. PubMed PMID: 26470685.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes. AU - Balamuth,Fran, AU - Weiss,Scott L, AU - Hall,Matt, AU - Neuman,Mark I, AU - Scott,Halden, AU - Brady,Patrick W, AU - Paul,Raina, AU - Farris,Reid W D, AU - McClead,Richard, AU - Centkowski,Sierra, AU - Baumer-Mouradian,Shannon, AU - Weiser,Jason, AU - Hayes,Katie, AU - Shah,Samir S, AU - Alpern,Elizabeth R, Y1 - 2015/10/23/ PY - 2015/05/28/received PY - 2015/08/24/revised PY - 2015/09/08/accepted PY - 2015/10/17/entrez PY - 2015/10/17/pubmed PY - 2016/4/8/medline SP - 1295 EP - 300.e4 JF - The Journal of pediatrics JO - J Pediatr VL - 167 IS - 6 N2 - OBJECTIVES: To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard. STUDY DESIGN: Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification. RESULTS: A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008). CONCLUSIONS: Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction. SN - 1097-6833 UR - https://www.unboundmedicine.com/medline/citation/26470685/Identifying_Pediatric_Severe_Sepsis_and_Septic_Shock:_Accuracy_of_Diagnosis_Codes_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3476(15)01040-9 DB - PRIME DP - Unbound Medicine ER -