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Abstract
IntroductionAdministrative data are used to generate estimates of sepsis epidemiology and can serve as source for quality indicators. Aim was to compare estimates on sepsis incidence and mortality based on different ICD-code abstraction strategies and to assess their validity for sepsis case identification based on a patient sample not pre-selected for presence of sepsis codes.Materials and methodsWe used the national DRG-statistics for assessment of population-level sepsis incidence and mortality. Cases were identified by three previously published International Statistical Classification of Diseases (ICD) coding strategies for sepsis based on primary and secondary discharge diagnoses (clinical sepsis codes (R-codes), explicit coding (all sepsis codes) and implicit coding (combined infection and organ dysfunction codes)). For the validation study, a stratified sample of 1120 adult patients admitted to a German academic medical center between 2007–2013 was selected. Administrative diagnoses were compared to a gold standard of clinical sepsis diagnoses based on manual chart review.ResultsIn the validation study, 151/937 patients had sepsis. Explicit coding strategies performed better regarding sensitivity compared to R-codes, but had lower PPV. The implicit approach was the most sensitive for severe sepsis; however, it yielded a considerable number of false positives. R-codes and explicit strategies underestimate sepsis incidence by up to 3.5-fold. Between 2007–2013, national sepsis incidence ranged between 231-1006/100,000 person-years depending on the coding strategy.ConclusionsIn the sample of a large tertiary care hospital, ICD-coding strategies for sepsis differ in their accuracy. Estimates using R-codes are likely to underestimate the true sepsis incidence, whereas implicit coding overestimates sepsis cases. Further multi-center evaluation is needed to gain better understanding on the validity of sepsis coding in Germany.
Highlights
MethodsWe used the national DRG-statistics for assessment of population-level sepsis incidence and mortality
Administrative data are used to generate estimates of sepsis epidemiology and can serve as source for quality indicators
In the US and several European countries, estimates on sepsis incidence are commonly drawn from retrospective studies based on hospital claims data using different International Classification of Diseases (ICD) codes for case identification [4, 5]
Summary
We used the national DRG-statistics for assessment of population-level sepsis incidence and mortality. Cases were identified by three previously published International Statistical Classification of Diseases (ICD) coding strategies for sepsis based on primary and secondary discharge diagnoses (clinical sepsis codes (R-codes), explicit coding (all sepsis codes) and implicit coding (combined infection and organ dysfunction codes)). ICD coding strategies for sepsis in claims data were selected based on a review of international studies applying ICD abstraction strategies (S1 File). Codes for five main coding strategies were selected and translated from ICD-9 to ICD-10-German Modification (GM): for sepsis: I) R-codes, II) explicit approach (all sepsis codes = microbiological sepsis codes and R-codes); for severe sepsis: III) R-codes, (IV) explicit and organ dysfunction codes and V) implicit approach (presence of infection and organ dysfunction codes, Angus method [5]).
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