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Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data.
Chest. 2017 02; 151(2):278-285.Chest

Abstract

BACKGROUND

Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data.

METHODS

We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three hospitals to estimate the accuracy of each method.

RESULTS

Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs 48.3%; P < .01), whereas positive predictive value was comparable (83% vs 89%; P = .23). Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 95% CI, 0.9%-1.6%).

CONCLUSIONS

A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated on the basis of ICD-9 codes.

Authors+Show Affiliations

Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Department of Medicine, Massachusetts General Hospital, Boston, MA.Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA. Electronic address: crhee1@partners.org.Department of Internal Medicine, Georgetown University Hospital, Washington, DC; Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.Division of Infectious Diseases, Georgetown University Hospital, Washington, DC.University HealthSystem Consortium, Chicago, IL; Department of Health Systems Management, Rush University, Chicago, IL.Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27452768

Citation

Kadri, Sameer S., et al. "Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data." Chest, vol. 151, no. 2, 2017, pp. 278-285.
Kadri SS, Rhee C, Strich JR, et al. Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. Chest. 2017;151(2):278-285.
Kadri, S. S., Rhee, C., Strich, J. R., Morales, M. K., Hohmann, S., Menchaca, J., Suffredini, A. F., Danner, R. L., & Klompas, M. (2017). Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. Chest, 151(2), 278-285. https://doi.org/10.1016/j.chest.2016.07.010
Kadri SS, et al. Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. Chest. 2017;151(2):278-285. PubMed PMID: 27452768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data. AU - Kadri,Sameer S, AU - Rhee,Chanu, AU - Strich,Jeffrey R, AU - Morales,Megan K, AU - Hohmann,Samuel, AU - Menchaca,Jonathan, AU - Suffredini,Anthony F, AU - Danner,Robert L, AU - Klompas,Michael, Y1 - 2016/07/22/ PY - 2016/04/29/received PY - 2016/06/08/revised PY - 2016/07/05/accepted PY - 2016/7/28/pubmed PY - 2017/5/26/medline PY - 2016/7/26/entrez KW - epidemiology KW - incidence KW - mortality KW - sepsis KW - septic shock KW - trends SP - 278 EP - 285 JF - Chest JO - Chest VL - 151 IS - 2 N2 - BACKGROUND: Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data. METHODS: We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three hospitals to estimate the accuracy of each method. RESULTS: Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs 48.3%; P < .01), whereas positive predictive value was comparable (83% vs 89%; P = .23). Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 95% CI, 0.9%-1.6%). CONCLUSIONS: A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated on the basis of ICD-9 codes. SN - 1931-3543 UR - https://www.unboundmedicine.com/medline/citation/27452768/Estimating_Ten_Year_Trends_in_Septic_Shock_Incidence_and_Mortality_in_United_States_Academic_Medical_Centers_Using_Clinical_Data_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0012-3692(16)52673-7 DB - PRIME DP - Unbound Medicine ER -