In the Journals

Coding variations may have resulted in discrepancy in sepsis trends

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November 20, 2014

A discrepancy may exist between trends in the incidence of hospitalizations coded for sepsis and hospitalizations with corresponding objective clinical markers, according to recent study results.

Researchers from Harvard Medical School, Harvard Pilgrim Health Care Institute and Brigham and Women’s Hospital reviewed cases of all patients admitted to Massachusetts General Hospital and Brigham and Women’s Hospital from 2003 through 2012. They compared the case identification rates of septicemia, sepsis and severe sepsis using five claims methods with the use of objective clinical measures, including positive blood cultures, vasopressors and/or lactic acid concentrations.

The researchers found the annual incidence rate of hospitalizations with sepsis claims increased substantially during a 10-year period — ranging from a 54% increase by the “Martin” definition of sepsis (P<.001 for linear trend), which consists of ICD-9-CM codes that imply a disseminated bloodstream infection like septicemia, bacteremia and fungemia, to a 706% increase for explicit severe sepsis/septic shock codes (P=.001). Conversely, there was a 17% decrease in the incidence of hospitalizations with positive blood cultures (P=.006) and no significant fluctuation in hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis (P=.098).

There was an increase in the sensitivity of sepsis claims for capturing hospitalizations with positive blood cultures with concurrent vasopressors and/or lactic acidosis (P<.001 for all methods), and a reduction from 50% to 30% in septicemia hospitalizations with positive blood cultures (P<.001).

The researchers said it was unclear whether these discrepancies were attributable to changes in coding practices.

“These findings support the concern that changing diagnosis and coding practices undermine the validity of sepsis trends derived from administrative data, and underscore the need for more objective methods to better track changes in sepsis rates over time,” the researchers wrote.

Disclosure: One of the researchers is conducting a trial in which participating hospitals are receiving product contributions from Sage and Molnlycke.

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