Identifying Patients With Severe Sepsis Using Administrative Claims

Abstract

Background Severe sepsis is a common and costly problem. Although consistently defined clinically by consensus conference since 1991, there have been several different implementations of the severe sepsis definition using ICD-9-CM codes for research. We conducted a single center, patient-level validation of one common implementation of the severe sepsis definition, the so-called “Angus” implementation. Methods Administrative claims for all hospitalizations for patients initially admitted to general medical services from an academic medical center in 2009–2010 were reviewed. On the basis of ICD-9-CM codes, hospitalizations were sampled for review by three internal medicine-trained hospitalists. Chart reviews were conducted with a structured instrument, and the gold standard was the hospitalists’ summary clinical judgment on whether the patient had severe sepsis. Results 3,146 (13.5%) hospitalizations met ICD-9-CM criteria for severe sepsis by the Angus implementation (“Angus-positive”) and 20,142 (86.5%) were Angus-negative. Chart reviews were performed for 92 randomly-selected Angus-positive and 19 randomly-selected Angus-negative hospitalizations. Reviewers had a kappa of 0.70. The Angus implementation’s positive predictive value (PPV) was 70.7% (95%CI: 51.2%, 90.5%). The negative predictive value was 91.5% (95%CI: 79.0%, 100%). The sensitivity was 50.4% (95%CI: 14.8%, 85.7%). Specificity was 96.3% (95%CI: 92.4%, 100%). Two alternative ICD-9-CM implementations had high PPVs but sensitivities of less than 20%. Conclusions The Angus implementation of the international consensus conference definition of severe sepsis offers a reasonable but imperfect approach to identifying patients with severe sepsis when compared with a gold standard of structured review of the medical chart by trained hospitalists.

Late mortality after sepsis: propensity matched cohort study

“…First, we used claims based algorithms to identify our cohorts. The method for identifying sepsis is commonly used and has similar specificity and greater sensitivity to other claims based methods 19. For the non-sepsis infection and sterile inflammation cohorts, we required a principal diagnosis of infection and sterile inflammatory condition, respectively, to increase the specificity of these cohorts.…”

“…Following the procedure of Angus and colleagues, we defined admissions with sepsis by synchronous ICD-9 (international classification of diseases, ninth revision) CM codes for infection and acute organ dysfunction, or explicit coding of severe sepsis or septic shock1 19 (see table A in appendix 5). This reflects the third international consensus definition that sepsis is “life-threatening organ dysfunction caused by a dysregulated host response to infection”20 or what the previous sepsis definition conceptualized as “severe sepsis.”14 We did not require explicit sepsis codes because they were not introduced until 2002, after the start of our study.…”

Practice Patterns and Outcomes Associated With Use of Anticoagulation Among Patients With Atrial Fibrillation During Sepsis

“…These data represent approximately 20% of hospitalized patients in nonfederal US hospitals. 12 Patients with sepsis present on admission were selected through use of International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM ) codes for sepsis (038.x) with high positive predictive value (>90%) 13 combined with receipt of an antibiotic. Atrial fibrillation was identified via ICD-9-CM code 427.31 (positive predictive value, 70%-96%; median, 89%) 14 and patients with AF were subclassified as having preexisting AF (eg, diagnosed prevalent AF that was present on admission) or newly diagnosed AF (eg, incident AF that was not present on admission).…”

Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis

“…We performed an analysis limited to severe sepsis cases identified through a more sensitive, but less specific, algorithm for severe sepsis developed by Angus and colleagues (22) that identifies severe sepsis through concomitant infection and acute organ dysfunction codes (positive predictive value, 70%) and performed a separate analysis limited to the less sensitive and more specific explicit ICD-9-CM codes for severe sepsis (995.92, 785.52, positive predictive value z100%) (23,24).…”