Abstract
Sepsis is a growing concern for health systems, but the epidemiology of sepsis is poorly characterised. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations. Cohort study including 378 general practices in England from Clinical Practice Research Datalink (CPRD) GOLD database from 2002-2017 with 36,209,676 patient-years of follow-up with linked Hospital Episode Statistics (HES) and Office for National Statistics (ONS) mortality registrations. Incident sepsis episodes were identified for each source. Concurrent records from different sources were identified and age-standardised and age-specific incidence rates compared. Logistic regression analysis evaluated associations of gender, age-group, fifth of deprivation and period of diagnosis with concurrent sepsis recording. There were 20,206 first episodes of sepsis from primary care, 20,278 from HES and 13,972 from ONS. There were 4,117 (20%) first HES sepsis events and 2,438 (17%) mortality records concurrent with incident primary care sepsis records within 30 days. Concurrent HES and primary care records of sepsis within 30 days before or after first diagnosis were higher at younger or older ages and for patients with the most recent period of diagnosis. Those diagnosed during 2007:2011 were less likely to have a concurrent HES record given CPRD compared to those diagnosed during 2012-2017 (odd ratio 0.65, 95% confidence interval 0.60-0.70). At age 85 and older, primary care incidence was 5.22 per 1,000 patient years (95% CI 1.75-11.97) in men and 3.55 (0.87-9.58) in women which increased to 10.09 (4.86-18.51) for men and 7.22 (2.96-14.72) for women after inclusion of all three sources. Explicit recording of 'sepsis' is inconsistent across healthcare sectors with a high proportion of non-concurrent records. Incidence estimates are higher when linked data are analysed.
Highlights
Sepsis is a growing concern for health systems
The term sepsis was introduced by ancient Greek physicians, but only in recent years has sepsis come to be defined as a syndrome resulting from the interaction between an acute infection and host response leading to new organ dysfunction [3]
There were 20,206 patients with a first episode of sepsis recorded in primary care Electronic health records (EHRs), 20,278 in Hospital Episode Statistics (HES) and 13,972 in Office for National Statistics (ONS)
Summary
Sepsis is a growing concern for health systems. In the health care systems of high-income countries, records of ‘sepsis’ have been increasing in both hospital and primary care settings [4,5,6]. A study from the U.S Massachusetts General Hospital [7] found that recording of severe sepsis or septic shock increased by 706% in the decade between 2003 and 2012, while objective markers of severe infection, including positive blood cultures, remained stable or decreased. Alongside increasing use of the term sepsis, case definitions have expanded to include patients with evidence of both acute infection and acute organ dysfunction as having ‘implicit sepsis’ even when sepsis was not explicitly diagnosed [2,8]. We evaluated sepsis recording across primary care electronic records, hospital episodes and mortality registrations
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
