Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Health Services Research

Background:

• Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.
• Accurate identification of sepsis onset is crucial for timely intervention and improved patient outcomes.
• Distinguishing between pre-ICU and during-ICU onset of sepsis is essential for specific research and clinical management.

Purpose of the Study:

• To develop and validate a high-specificity identification strategy for patients whose sepsis initially appeared during their Intensive Care Unit (ICU) stay.
• To assess the utility of administrative codes combined with physiologic and laboratory data for sepsis identification.
• To determine the proportion of identified sepsis cases with onset during the ICU admission.

Main Methods:

• Retrospective study of patients discharged from an academic hospital (September 2013 - October 2014).
• Utilized administrative codes and minimal physiologic/laboratory data to screen for high-risk ICU sepsis.
• Independent clinical chart review by two clinicians to verify sepsis onset during ICU stay.

Main Results:

• Clinical review confirmed sepsis in 93.8% (437/466) of ICU stays.
• Of confirmed sepsis cases, only 34.6% (151/437) appeared to develop sepsis during their ICU admission.
• The strategy identified a high proportion of authentic sepsis patients (94%) but lacked specificity regarding onset timing.

Conclusions:

• Administrative codes combined with SIRS criteria can effectively identify patients with sepsis admitted to the ICU.
• A significant proportion of identified sepsis cases do not appear to have originated during the ICU stay.
• Studies requiring precise sepsis onset timing necessitate clinician review and verification of the onset period during ICU monitoring.