Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes

Balamuth, Fran; Weiss, Scott L.; Hall, Matt; Neuman, Mark I.; Scott, Halden F.; Brady, Patrick; Paul, Raina; Farris, Reid; McClead, Richard E.; Centkowski, Sierra; Baumer-Mouradian, Shannon H.; Weiser, Jason; Hayes, Katie; Shah, Samir S.; Alpern, Elizabeth R.

doi:10.1016/j.jpeds.2015.09.027

Cited by 55 publications

(42 citation statements)

References 19 publications

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“…Second, using ICD-9-CM codes for infection plus organ dysfunction to identify pediatric sepsis is controversial. 17,18,36 Notably, patients with more specific ICD-9-CM sepsis codes had a trend toward decreased mortality and less dialysis in the LR group. Moreover, because identification and timing of surgical interventions is limited using administrative codes, it was difficult to fully account for a possible surgical preference to use LR.…”

Section: Discussionmentioning

confidence: 98%

Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study

Weiss

Keele

Balamuth

et al. 2017

The Journal of Pediatrics

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Objective To test the hypothesis that resuscitation with balanced fluids (lactated Ringer [LR]) is associated with improved outcomes compared with normal saline (NS) in pediatric sepsis. Study design We performed matched analyses using data from 12 529 patients <18 years of age with severe sepsis/septic shock at 382 US hospitals between 2000 and 2013 to compare outcomes with vs without LR as part of initial resuscitation. Patients receiving LR were matched 1:1 to patients receiving only NS (NS group), including separate matches for any (LR-any group) or exclusive (LR-only group) LR use. Outcomes included 30-day hospital mortality, acute kidney injury, new dialysis, and length of stay. Results The LR-any group was older, received larger crystalloid volumes, and was less likely to have malignancies than the NS group. After matching, mortality was not different between LR-any (7.2%) and NS (7.9%) groups (risk ratio 0.99, 95% CI 0.98, 1.01; P = .20). There were no differences in secondary outcomes except longer hospital length of stay in LR-any group (absolute difference 2.4, 95% CI 1.4, 5.0 days; P < .001). Although LR was preferentially used as adjunctive fluid with large-volume resuscitation or first-line fluid in patients with lower illness severity, outcomes were not different after matching stratified by volume and proportionate LR utilization, including for patients in the LR-only group. Conclusions Balanced fluid resuscitation with LR was not associated with improved outcomes compared with NS in pediatric sepsis. Although the current practice of NS resuscitation is justified, selective LR use necessitates a prospective trial to definitively determine comparative effectiveness among crystalloids.

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Section: Discussionmentioning

confidence: 98%

Crystalloid Fluid Choice and Clinical Outcomes in Pediatric Sepsis: A Matched Retrospective Cohort Study

Weiss

Keele

Balamuth

et al. 2017

The Journal of Pediatrics

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“…However, the consensus definition relies on laboratory data that may not be available in LMICs. In addition, the use of administrative data, as in this study, is associated with selection and reporting bias because of the challenges in disaggregating sepsis from severe sepsis due to the use of the ICD-10 code (26,27). Because administrative data were used in this study, the definition of sepsis may not necessarily meet the consensus criteria; hence, comparability with studies that used the consensus definition may be limited.…”

Section: Discussionmentioning

confidence: 99%

Burden of Paediatric Sepsis in a Tertiary Centre from a Developing Country

Olugbuyi¹,

Swaby²,

Roberts³

et al. 2017

West Indian Med J

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Background: Sepsis causes significant paediatric morbidity and mortality in developing countries. This paper describes the outcome of paediatric sepsis in the University Hospital of the West Indies (UHWI), Jamaica, using administrative data from hospital records from 2010 to 2014. Objective: To provide baseline data on the burden and outcome of paediatric sepsis in a tertiary institution in Jamaica between 2010 and 2014 so as to embark on initiatives to build capacity to provide care in order to decrease the burden and improve the outcomes from sepsis in children. Methods: Data were abstracted from electronic discharge summaries of children hospitalized at the UHWI, a tertiary centre that accepts referrals for newborns and children with complex disorders. The medical records of children aged 0-16 years who were hospitalized with a diagnosis of sepsis, septicaemia and neonatal sepsis were reviewed, using the World Health Organization's International Classification of Diseases, 10 th Revision (ICD-10). Demographic and outcome data were extracted. Results: Among 7011 children aged 0-16 years who were admitted, sepsis accounted for 801 hospitalizations in 782 children with a male to female ratio of 1.27 to 1. Neonates comprised 86% (n = 691), of which 36.2% (n = 250) were preterm. The median duration of hospitalization was 10 days (range: 0-366 days; interquartile range: 7-19 days). The sepsis-attributable mortality rate was 10.1% (n = 70) in neonates and was higher in preterm versus term neonates (18.4%, n = 46/250 versus 6.0%, n = 26/434, respectively). The annual crude mortality rate for paediatric sepsis was 9-11% (12 per 1000 paediatric hospitalizations). Conclusion: Sepsis accounted for a high number of admissions and consumed significant resources as evidenced by the long duration of hospitalization. The mortality rate for paediatric sepsis was high, especially in newborns. Targeted interventions are needed to reduce the sepsis-attributable burden and improve outcomes established by the Global Sepsis Alliance and United Nations' Sustainable Development Goals.

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“…Sepsis was coded in the data set using the ICD-9 codes for severe sepsis (995.92) and septic shock (785.52). 9 Per Balamuth et al, 9 using the ICD-9 codes for severe sepsis and septic shock more accurately identified cases of pediatric sepsis compared to the use of ICD-9 combinations that include codes for both infections and organ failure ( Table 1).…”

Section: Methodsmentioning

confidence: 99%