Abstract
BackgroundSepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. We hypothesized that emergency department (ED) charges may be associated with hospital mortality, and could be a surrogate marker of severity of illness for research purposes. The objective of this study was to measure concordance between ED charges and mortality in admitted patients with severe sepsis or septic shock.MethodsCohort study of all adult patients presenting to a 60,000-visit Midwestern academic ED with severe sepsis or septic shock (by ICD-9 codes) between July 1, 2008 and June 30, 2010. Data on demographics, admission APACHE-II score, and disposition was extracted from the medical record, and comorbidities were identified from diagnosis codes using the Elixhauser methodology. Summary statistics were reported and bivariate concordance was tested using Pearson correlation. Logistic regression models for 28-day mortality were developed to measure the independent association with mortality.ResultsWe included a total of 294 patients in the analysis. We found that ED charges were inversely related to mortality (adjusted OR 0.829 per $1000 increase in total ED charges, 95%CI 0.702–0.980). ED charges were also independently associated with 28-day hospital-free and ICU-free days (0.74 days increase per $1000 additional ED charges, 95%CI 0.06–1.41 and 0.81 days increase per $1000 additional ED charges, 95%CI 0.05–1.56, respectively). ED charges were also associated with APACHE-II score ($34 total ED charges per point increase in APACHE-II score, 95%CI $6–62).ConclusionsED charges in administrative data sets are associated with in-hospital mortality and health care utilization, likely related to both illness severity and intensity of early sepsis resuscitation. ED charges may have a role in risk adjustment models using administrative data for acute care research.
Highlights
Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data
Medical comorbidities, admission diagnosis, and surgical status impact morbidity and mortality significantly, so risk adjustment models are critical to compare outcomes across clinical sepsis studies [8]. Illness severity scores, such as the Acute Physiology and Chronic Health Evaluation, 2nd edition (APACHE-II) score [9], the Simplified Acute Physiology Score (SAPS), and the Sequential Organ Failure Assessment (SOFA) score are valid scoring systems for critically ill patients [10,11,12], but the parameters used to calculate these scores are not captured in claims
Mortality emergency department (ED) charges were significantly associated with mortality, with higher ED charges being associated with lower mortality
Summary
Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. Medical comorbidities, admission diagnosis, and surgical status impact morbidity and mortality significantly, so risk adjustment models are critical to compare outcomes across clinical sepsis studies [8]. Illness severity scores, such as the Acute Physiology and Chronic Health Evaluation, 2nd edition (APACHE-II) score [9], the Simplified Acute Physiology Score (SAPS), and the Sequential Organ Failure Assessment (SOFA) score are valid scoring systems for critically ill patients [10,11,12], but the parameters used to calculate these scores are not captured in claims
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