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The Comparative Epidemiology of Pediatric Severe Sepsis.
J Intensive Care Med. 2019 Jun; 34(6):472-479.JI

Abstract

OBJECTIVE

To determine whether the coding strategies used to identify severe sepsis in administrative data sets could identify cases with comparable case mix, hospitalization characteristics, and outcomes as a cohort of children diagnosed with severe sepsis using strict clinical criteria.

METHODS

We performed a retrospective cohort study using data from 2005 to 2011 from the New York and Florida State Inpatient Databases, available from the US Healthcare Cost and Utilization Project. We compared 4 coding strategies: the single International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for (1) severe sepsis or (2) septic shock, and the algorithms developed by (3) Angus et al or (4) Martin et al, which use a combination of ICD-9-CM codes for infection and organ dysfunction. We compared the cases identified by each strategy with each other and with children enrolled in the REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspectiVE (RESOLVE) trial.

RESULTS

The Angus criteria was 9 times larger (n = 23 995) than the smallest cohort, identified by the "septic shock" code (n = 2 601). Cases identified by the Angus and Martin strategies had low mortality rates, while the cases identified by the "severe sepsis" and "septic shock" codes had much higher mortality at all time points (eg, 28-day mortality of 4.4% and 7.4% vs 15.4% and 16.0%, respectively). Mortality in the "severe sepsis" and "septic shock" code cohorts was similar to that presented in the RESOLVE trial.

CONCLUSIONS

The ICD-9-CM codes for "severe sepsis" and "septic shock" identify smaller but higher acuity cohorts of patients that more closely resemble the children enrolled in the largest clinical trial of pediatric severe sepsis to date.

Authors+Show Affiliations

1 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.2 Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, MO, USA.1 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.2 Division of Infectious Diseases, Department of Medicine, Washington University in St Louis, St Louis, MO, USA. 3 Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

29034782

Citation

Hartman, Mary E., et al. "The Comparative Epidemiology of Pediatric Severe Sepsis." Journal of Intensive Care Medicine, vol. 34, no. 6, 2019, pp. 472-479.
Hartman ME, Saeed MJ, Powell KN, et al. The Comparative Epidemiology of Pediatric Severe Sepsis. J Intensive Care Med. 2019;34(6):472-479.
Hartman, M. E., Saeed, M. J., Powell, K. N., & Olsen, M. A. (2019). The Comparative Epidemiology of Pediatric Severe Sepsis. Journal of Intensive Care Medicine, 34(6), 472-479. https://doi.org/10.1177/0885066617735783
Hartman ME, et al. The Comparative Epidemiology of Pediatric Severe Sepsis. J Intensive Care Med. 2019;34(6):472-479. PubMed PMID: 29034782.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Comparative Epidemiology of Pediatric Severe Sepsis. AU - Hartman,Mary E, AU - Saeed,Mohammed J, AU - Powell,Kimberly N, AU - Olsen,Margaret A, Y1 - 2017/10/15/ PY - 2017/10/17/pubmed PY - 2019/12/21/medline PY - 2017/10/17/entrez KW - KW - epidemiology KW - mortality KW - sepsis KW - septic shock SP - 472 EP - 479 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 34 IS - 6 N2 - OBJECTIVE: To determine whether the coding strategies used to identify severe sepsis in administrative data sets could identify cases with comparable case mix, hospitalization characteristics, and outcomes as a cohort of children diagnosed with severe sepsis using strict clinical criteria. METHODS: We performed a retrospective cohort study using data from 2005 to 2011 from the New York and Florida State Inpatient Databases, available from the US Healthcare Cost and Utilization Project. We compared 4 coding strategies: the single International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for (1) severe sepsis or (2) septic shock, and the algorithms developed by (3) Angus et al or (4) Martin et al, which use a combination of ICD-9-CM codes for infection and organ dysfunction. We compared the cases identified by each strategy with each other and with children enrolled in the REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspectiVE (RESOLVE) trial. RESULTS: The Angus criteria was 9 times larger (n = 23 995) than the smallest cohort, identified by the "septic shock" code (n = 2 601). Cases identified by the Angus and Martin strategies had low mortality rates, while the cases identified by the "severe sepsis" and "septic shock" codes had much higher mortality at all time points (eg, 28-day mortality of 4.4% and 7.4% vs 15.4% and 16.0%, respectively). Mortality in the "severe sepsis" and "septic shock" code cohorts was similar to that presented in the RESOLVE trial. CONCLUSIONS: The ICD-9-CM codes for "severe sepsis" and "septic shock" identify smaller but higher acuity cohorts of patients that more closely resemble the children enrolled in the largest clinical trial of pediatric severe sepsis to date. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/29034782/The_Comparative_Epidemiology_of_Pediatric_Severe_Sepsis_ L2 - https://journals.sagepub.com/doi/10.1177/0885066617735783?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -