Sepsis/InfectionFiltering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol
Section snippets
Background
Sepsis is the life-threatening inflammatory response to infection [1]. In 2011, septicemia ranked as the most expensive condition for all United States hospitalizations accounting for 20.3 billion dollars [2]. Sepsis frequently causes inpatient death [3]. Survivors fare poorly: 26% require readmission within 30 days and 48% within 180 days [4], [5]. Almost half of all patients who survive severe sepsis (sepsis accompanied by organ failure) to hospital discharge die within the following year [6].
Ethical approval, study design, search strategy
This study was conducted under the approval of the Emory University Institutional Review Board. In this work, we retrospectively studied 6 ICUs (1 27-bed neurosurgical, 1 20-bed general surgical, 2 7-bed medical, and 2 9-bed cardiothoracic) at Emory University Hospital, a 605-bed acute care teaching facility, between September 1, 2013 and October 31, 2014. The search strategy began with all 24,323 hospital discharges that occurred during this timeframe. The screening protocol was applied to
Results
A total of 24,323 encounters were discharged from the 605 hospital beds between September 1, 2013 and October 31, 2014 (Fig. 3). The initial physiologic exclusion criteria resulted in 466 encounters that (1) received an administrative code and (2) met 2 of 4 SIRS criteria initially in the ICU, and thus these 466 encounters constituted the initial study population. Of the 466 encounters with administratively coded sepsis and valid SIRS physiology, clinical chart review identified sepsis in 437
Discussion
The purpose of this effort was to evaluate a protocol that could rapidly and reliably identify a small cohort of patients whose sepsis initially appeared during their ICU stay. These patients represent a first cohort for precision medicine: early identification and rapid, tailored response to this life-threatening condition. We found that we could reliably identify a patient population with sepsis by coupling a refined code set with SIRS criteria. Manual review revealed a 6% error rate. The
Conclusions
Coupling a refined administrative code set with SIRS criteria screens for authentic sepsis yielded a 93.8% positive predictive value. Errors arose from shock states subsequently attributed to non-septic etiologies. Approximately 1/3 of patients screened manifested sepsis for the first time during (not prior to) the ICU admission. This subpopulation is of significant importance to studies using high-intensity monitoring for early detection and targeted treatment of sepsis.
Conflicts of interest
None.
Funding
This work was supported by the Emory University Center for Critical Care; and the Surgical and Critical Care Initiative. The funding sources had no role in study design, data collection, data analysis, data interpretation, in writing the report, nor in the decision to submit the article for publication.
Acknowledgements
The authors acknowledge the assistance of Qiao Li, PhD, Gari Clifford, PhD, Monica Crubezy, PhD, Terry Willey, and Sara Gregg, MHA.
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