Trends in Sepsis and Infection Sources in the United States. A Population-Based Study
- 1 February 2015
- journal article
- Published by American Thoracic Society in Annals of the American Thoracic Society
- Vol. 12 (2), 216-220
- https://doi.org/10.1513/annalsats.201411-498bc
Abstract
Stakeholders seek to monitor processes and outcomes of care among patients with sepsis, but use of administrative data for sepsis surveillance is controversial. Prior studies using only principal diagnoses from claims data have shown a trend of rising sepsis incidence with falling infection incidence, implying that administrative data are inaccurate for sepsis surveillance. Because a sepsis diagnosis often modifies an infection site diagnosis, we sought to investigate trends in sepsis and infection using both principal and secondary diagnoses in administrative data. This was a retrospective cohort study. We used data from the Nationwide Inpatient Sample years 2003 to 2009 to identify age-standardized, population-based trends in sepsis and infection using all available diagnosis codes. Infection sites were defined as bacteremia, pneumonia, urinary tract, skin/soft tissue, and gastrointestinal; codes for septicemia, sepsis, severe sepsis, and septic shock were used to identify "sepsis." We identified patients with infection and mechanical ventilation to estimate incidence of severe sepsis without requiring specific claims for sepsis or acute organ failure. We identified 53.9 million adult infection hospitalizations during the years 2003 to 2009; average age was 63 years, 61% of patients were women, and 70% reported white race, 14% black, and 11% Hispanic ethnicity. Incidence of hospitalizations with an infection claim increased from 3,147/100,000 U.S. residents in 2003 to 3,480/100,000 in 2009 (11% increase), whereas hospitalizations with sepsis claims increased from 359/100,000 to 535/100,000 residents during the same time frame (49% increase); P = 0.009 between infection and sepsis trends. The proportion of infection hospitalizations with a sepsis claim increased from 7.5% in 2003 to 11.5% in 2009 (54% increase). The incidence of hospitalizations with both an infection and mechanical ventilation claim during 2003 was 173/100,000 as compared with 251/100,000 in 2009 (45% increase); P = 0.76 compared with sepsis trends. Sepsis claims are increasing at a greater rate than infection claims but are not inversely related. Trends in sepsis are similar to trends in infection cases requiring mechanical ventilation. Further studies should seek to identify the optimal algorithms to identify sepsis within administrative data and explore potential mechanisms for the increasing incidence of infection and sepsis in the United States.Keywords
This publication has 24 references indexed in Scilit:
- Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.2014
- Identifying Patients With Severe Sepsis Using Administrative ClaimsMedical Care, 2014
- Hospital readmission and healthcare utilization following sepsis in community settingsJournal of Hospital Medicine, 2014
- Severe Sepsis Cohorts Derived From Claims-Based Strategies Appear to be Biased Toward a More Severely Ill Patient Population*Critical Care Medicine, 2013
- An evaluation of the diagnostic accuracy of the 1991 American College of Chest Physicians/Society of Critical Care Medicine and the 2001 Society of Critical Care Medicine/European Society of Intensive Care Medicine/American College of Chest Physicians/American Thoracic Society/Surgical Infection Society sepsis definition*Critical Care Medicine, 2012
- Incident Stroke and Mortality Associated With New-Onset Atrial Fibrillation in Patients Hospitalized With Severe SepsisJama-Journal Of The American Medical Association, 2011
- Nationwide Trends of Severe Sepsis in the 21st Century (2000–2007)Social psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2011
- Rapid increase in hospitalization and mortality rates for severe sepsis in the United States: A trend analysis from 1993 to 2003*Critical Care Medicine, 2007
- Comorbidity Measures for Use with Administrative DataMedical Care, 1998
- Multiple Organ Dysfunction ScoreCritical Care Medicine, 1995