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Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database.
Crit Care Med. 2019 02; 47(2):e129-e135.CC

Abstract

OBJECTIVES

To compare the performance of three methods of identifying children with severe sepsis and septic shock from the Virtual Pediatric Systems database to prospective screening using consensus criteria.

DESIGN

Observational cohort study.

SETTING

Single-center PICU.

PATIENTS

Children admitted to the PICU in the period between March 1, 2012, and March 31, 2014.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

During the study period, all PICU patients were prospectively screened daily for sepsis, and those meeting consensus criteria for severe sepsis or septic shock on manual chart review were entered into the sepsis registry. Of 7,459 patients admitted to the PICU during the study period, 401 met consensus criteria for severe sepsis or septic shock (reference standard cohort). Within Virtual Pediatric Systems, patients identified using "Martin" (n = 970; κ = 0.43; positive predictive value = 34%; F1 = 0.48) and "Angus" International Classification of Diseases, 9th Edition, Clinical Modification codes (n = 1387; κ = 0.28; positive predictive value = 22%; F1 = 0.34) showed limited agreement with the reference standard cohort. By comparison, explicit International Classification of Diseases, 9th Edition, Clinical Modification codes for severe sepsis (995.92) and septic shock (785.52) identified a smaller, more accurate cohort of children (n = 515; κ = 0.61; positive predictive value = 57%; F1 = 0.64). PICU mortality was 8% in the reference standard cohort and the cohort identified by explicit codes; age, illness severity scores, and resource utilization did not differ between groups. Analysis of discrepancies between the reference standard and Virtual Pediatric Systems explicit codes revealed that prospective screening missed 66 patients with severe sepsis or septic shock. After including these patients in the reference standard cohort as an exploratory analysis, agreement between the cohort of patients identified by Virtual Pediatric Systems explicit codes and the reference standard cohort improved (κ = 0.73; positive predictive value = 70%; F1 = 0.75).

CONCLUSIONS

Children with severe sepsis and septic shock are best identified in the Virtual Pediatric Systems database using explicit diagnosis codes for severe sepsis and septic shock. The accuracy of these codes and level of clinical detail available in the Virtual Pediatric Systems database allow for sophisticated epidemiologic studies of pediatric severe sepsis and septic shock in this large, multicenter database.

Authors+Show Affiliations

Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA.Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA.Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA. Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA.Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA.Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Pediatric Sepsis Program, Children's Hospital of Philadelphia, Philadelphia, PA.

Pub Type(s)

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

Language

eng

PubMed ID

30394917

Citation

Lindell, Robert B., et al. "Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database." Critical Care Medicine, vol. 47, no. 2, 2019, pp. e129-e135.
Lindell RB, Nishisaki A, Weiss SL, et al. Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database. Crit Care Med. 2019;47(2):e129-e135.
Lindell, R. B., Nishisaki, A., Weiss, S. L., Balamuth, F., Traynor, D. M., Chilutti, M. R., Grundmeier, R. W., & Fitzgerald, J. C. (2019). Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database. Critical Care Medicine, 47(2), e129-e135. https://doi.org/10.1097/CCM.0000000000003541
Lindell RB, et al. Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database. Crit Care Med. 2019;47(2):e129-e135. PubMed PMID: 30394917.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of Methods for Identification of Pediatric Severe Sepsis and Septic Shock in the Virtual Pediatric Systems Database. AU - Lindell,Robert B, AU - Nishisaki,Akira, AU - Weiss,Scott L, AU - Balamuth,Fran, AU - Traynor,Danielle M, AU - Chilutti,Marianne R, AU - Grundmeier,Robert W, AU - Fitzgerald,Julie C, PY - 2018/11/6/pubmed PY - 2019/11/13/medline PY - 2018/11/6/entrez SP - e129 EP - e135 JF - Critical care medicine JO - Crit Care Med VL - 47 IS - 2 N2 - OBJECTIVES: To compare the performance of three methods of identifying children with severe sepsis and septic shock from the Virtual Pediatric Systems database to prospective screening using consensus criteria. DESIGN: Observational cohort study. SETTING: Single-center PICU. PATIENTS: Children admitted to the PICU in the period between March 1, 2012, and March 31, 2014. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: During the study period, all PICU patients were prospectively screened daily for sepsis, and those meeting consensus criteria for severe sepsis or septic shock on manual chart review were entered into the sepsis registry. Of 7,459 patients admitted to the PICU during the study period, 401 met consensus criteria for severe sepsis or septic shock (reference standard cohort). Within Virtual Pediatric Systems, patients identified using "Martin" (n = 970; κ = 0.43; positive predictive value = 34%; F1 = 0.48) and "Angus" International Classification of Diseases, 9th Edition, Clinical Modification codes (n = 1387; κ = 0.28; positive predictive value = 22%; F1 = 0.34) showed limited agreement with the reference standard cohort. By comparison, explicit International Classification of Diseases, 9th Edition, Clinical Modification codes for severe sepsis (995.92) and septic shock (785.52) identified a smaller, more accurate cohort of children (n = 515; κ = 0.61; positive predictive value = 57%; F1 = 0.64). PICU mortality was 8% in the reference standard cohort and the cohort identified by explicit codes; age, illness severity scores, and resource utilization did not differ between groups. Analysis of discrepancies between the reference standard and Virtual Pediatric Systems explicit codes revealed that prospective screening missed 66 patients with severe sepsis or septic shock. After including these patients in the reference standard cohort as an exploratory analysis, agreement between the cohort of patients identified by Virtual Pediatric Systems explicit codes and the reference standard cohort improved (κ = 0.73; positive predictive value = 70%; F1 = 0.75). CONCLUSIONS: Children with severe sepsis and septic shock are best identified in the Virtual Pediatric Systems database using explicit diagnosis codes for severe sepsis and septic shock. The accuracy of these codes and level of clinical detail available in the Virtual Pediatric Systems database allow for sophisticated epidemiologic studies of pediatric severe sepsis and septic shock in this large, multicenter database. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/30394917/Comparison_of_Methods_for_Identification_of_Pediatric_Severe_Sepsis_and_Septic_Shock_in_the_Virtual_Pediatric_Systems_Database_ L2 - https://dx.doi.org/10.1097/CCM.0000000000003541 DB - PRIME DP - Unbound Medicine ER -