Severe sepsis in the ICU is often missing in hospital discharge codes

Area of Science:

• Critical Care Medicine
• Epidemiology
• Health Informatics

Background:

• International Classification of Diseases (ICD) codes are used for severe sepsis epidemiology.
• Existing ICD code abstraction strategies vary in their application.
• Accurate patient identification is crucial for epidemiological studies.

Purpose of the Study:

• To compare three ICD code abstraction strategies against the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) consensus criteria for severe sepsis.
• To evaluate the accuracy of ICD code abstraction in identifying severe sepsis patients in an intensive care setting.

Main Methods:

• Utilized data from the Swedish Intensive Care Registry (2005-2009) including 9271 severe sepsis patients (≥ 18 years).
• Cross-referenced patients with the Swedish National Patient Register to assess fulfillment of ICD code compilations for severe sepsis at hospital discharge.
• Compared three established ICD code abstraction strategies (Angus et al., Flaatten, Martin et al.) against ACCP/SCCM criteria.

Main Results:

• A majority of severe sepsis patients (55.4%) were discharged without ICD codes matching any abstraction strategy.
• Only 10.3% of patients had ICD codes aligning with all three tested strategies.
• Proportions of patients identified by specific strategies were: Angus et al. (15.1%), Flaatten (39.8%), and Martin et al. (16.0%).

Conclusions:

• Current ICD code abstraction strategies are insufficient for accurately identifying severe sepsis patients based on ACCP/SCCM criteria.
• A significant disconnect exists between clinical diagnosis of severe sepsis and hospital discharge ICD coding.
• This inaccuracy hinders reliable epidemiological studies of severe sepsis.