Critical Care: Severe Sepsis and Septic Shock |

Diagnosis Code vs Clinical Criteria: Variable Outcomes in Patients With Severe Sepsis and Septic Shock FREE TO VIEW

Amanda Deis; Bristol Whiles; Patrick Miller; Steven Simpson
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University of Kansas School of Medicine, Kansas City, KS

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A187. doi:10.1016/j.chest.2016.02.193
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SESSION TITLE: Severe Sepsis and Septic Shock

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Saturday, April 16, 2016 at 05:15 PM - 06:15 PM

PURPOSE: To compare outcomes in patients with an ICD9 (995.92 or 785.52) vs patients with a clinical definition of severe sepsis without a diagnosis code.

METHODS: This is a retrospective cohort of patients with severe sepsis or septic shock admitted through the emergency department (ED) between 3/1/07-10/1/14. Criteria for severe sepsis required ≥1 of the following: a) ICD9 995.92, b) increased serum lactate, or c) ≥2 organ dysfunction sites (identified by ICD9 code or laboratory values). Criteria for septic shock required ≥1 of the following: a) ICD9 785.52, b) SBP<90, and/or c) MAP<65. Patients with severe sepsis and septic shock were analyzed separately.

RESULTS: A total of 7071 encounters with severe sepsis and/or septic shock were identified with a mean age of 60±16 years (mean±SD) and an overall mortality of 7.0%. 5499 (78%) encounters had severe sepsis alone, and 1572 (22%) had septic shock. Of patients with severe sepsis without shock, 3746 (68%) did not receive an ICD9 diagnosis code of 995.92. Diagnosed patients had a higher mortality (4.9% vs 2.16%, p<.00001), ICU admission rate (43% vs 24%, p<.00001), and hospital LOS (10.6 vs 8.19 days, p<.00001) when compared to patients identified by only clinical criteria. There was no difference in 30-day readmission rates between these two groups. Of the 1572 septic shock encounters identified, 629 (40%) did not receive an ICD9 diagnosis code of 785.52. Mortality was similar between septic shock encounters with an ICD9 vs clinical criteria (20% vs 21%, p=.588). Septic shock patients with an ICD9 code had higher ICU admission rate (79% vs 63%, p<0.0001) and 30-day readmission rate (29.7% vs 25.10%, p=.046). There was no difference in age, number of comorbidities, or number of organ dysfunction sites in patients with severe sepsis or septic shock who were identified by either method.

CONCLUSIONS: Patients identified by an ICD9 diagnosis code of 995.92 or 785.52 had higher ICU admission rates and longer hospital LOS when compared to patients identified by clinical criteria alone. ICD9 identification of severe sepsis encounters had a higher mortality. 30-readmission rate was highest in patients with septic shock identified by ICD9.

CLINICAL IMPLICATIONS: Further investigation is needed to identify why a large portion of patients admitted through the ED with severe sepsis or septic shock are not given a formal diagnosis code during their hospitalization. Evaluation of factors contributing to the variable outcomes seen in patients without a diagnosis code is of interest.

DISCLOSURE: The following authors have nothing to disclose: Amanda Deis, Bristol Whiles, Patrick Miller, Steven Simpson

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