[Systematic medical record review in Skåne. Diagnostic codes were often wrong in severe sepsis and septic shock]

The reliability of official registers of diagnosis depends on proper adherence to guidelines for diagnosis and diagnosis coding. Such guidelines for severe sepsis and septic shock have changed over the years, reflecting improved knowledge of these serious conditions. In order to investigate the compliance to current Swedish guidelines for diagnosis and coding of severe sepsis and septic shock, we studied the medical records from 300 patients with Escherichia coli bacteremia and 300 patients with Staphylococcus aureus bacteremia. Our study showed that out of 161 patients who fulfilled the criteria for either severe sepsis or septic shock, only 29 (18%) received an accurate diagnosis code. Thus, severe sepsis appears to be underappreciated in official registers of diagnosis in Sweden. It is important to improve the adherence to the present diagnosis guidelines in order for the registers to be reliable.