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The Comparative Epidemiology of Pediatric Severe Sepsis
Mary E Hartman1, Mohammed J Saeed2, Kimberly N Powell1
11 Division of Pediatric Critical Care Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA.
Insights
Administrative coding for severe sepsis using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes identified smaller, higher-acuity pediatric patient groups with outcomes similar to clinical trials.
Area of Science:
- Pediatric critical care medicine
- Health services research
- Epidemiology
Background:
- Accurate identification of severe sepsis in administrative data is crucial for research and quality improvement.
- Existing coding strategies vary in their ability to capture patient severity and outcomes.
Purpose of the Study:
- To evaluate the effectiveness of different International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding strategies in identifying pediatric severe sepsis cases.
- To compare the case mix, hospitalization characteristics, and outcomes of severe sepsis cohorts identified by administrative codes versus clinical criteria.
Main Methods:
- Retrospective cohort study using 2005-2011 New York and Florida State Inpatient Databases.
- Comparison of four coding strategies: single ICD-9-CM codes for severe sepsis or septic shock, and Angus et al. or Martin et al. algorithms.
- Comparison of identified cases with children in the REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspectiVE (RESOLVE) trial.
Main Results:
- The Angus criteria identified the largest cohort (n=23,995), while the 'septic shock' code identified the smallest (n=2,601).
- Angus and Martin strategies yielded low mortality rates.
- Severe sepsis and septic shock codes identified smaller, higher-acuity cohorts with significantly higher mortality rates, comparable to the RESOLVE trial.
Conclusions:
- ICD-9-CM codes for 'severe sepsis' and 'septic shock' identify distinct, higher-acuity pediatric patient populations.
- These specific ICD-9-CM codes better reflect the characteristics of patients in major pediatric severe sepsis clinical trials compared to broader algorithms.
Objective:
To determine whether the coding strategies used to identify severe sepsis in administrative data sets could identify cases with comparable case mix, hospitalization characteristics, and outcomes as a cohort of children diagnosed with severe sepsis using strict clinical criteria.
Methods:
We performed a retrospective cohort study using data from 2005 to 2011 from the New York and Florida State Inpatient Databases, available from the US Healthcare Cost and Utilization Project. We compared 4 coding strategies: the single International Classification of Diseases, Ninth Revision, Clinical Modification ( ICD-9-CM) codes for (1) severe sepsis or (2) septic shock, and the algorithms developed by (3) Angus et al or (4) Martin et al, which use a combination of ICD-9-CM codes for infection and organ dysfunction. We compared the cases identified by each strategy with each other and with children enrolled in the REsearching severe Sepsis and Organ dysfunction in children: a gLobal perspectiVE (RESOLVE) trial.
Results:
The Angus criteria was 9 times larger (n = 23 995) than the smallest cohort, identified by the "septic shock" code (n = 2 601). Cases identified by the Angus and Martin strategies had low mortality rates, while the cases identified by the "severe sepsis" and "septic shock" codes had much higher mortality at all time points (eg, 28-day mortality of 4.4% and 7.4% vs 15.4% and 16.0%, respectively). Mortality in the "severe sepsis" and "septic shock" code cohorts was similar to that presented in the RESOLVE trial.
Conclusions:
The ICD-9-CM codes for "severe sepsis" and "septic shock" identify smaller but higher acuity cohorts of patients that more closely resemble the children enrolled in the largest clinical trial of pediatric severe sepsis to date.