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Original Research |

Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data

Sameer S. Kadri, MD, MS; Chanu Rhee, MD, MPH; Jeffrey R. Strich, MD; Megan K. Morales, MD; Samuel Hohmann, PhD; Jonathan Menchaca, BA; Anthony F. Suffredini, MD; Robert L. Danner, MD; Michael Klompas, MD, MPH
Author and Funding Information

Conflicts of interests: None of the authors have any potential conflicts of interest to disclose.

Disclaimer:The opinions expressed in this article are the authors’ own and do not represent any position or policy of the National Institutes of Health, the Department of Health and Human Services, or the United States government.

1Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda MD

2Department of Medicine, Massachusetts General Hospital, Boston, MA

3Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston MA

4Division of Infectious Diseases, Brigham and Women’s Hospital, Boston MA

5Department of Internal Medicine, Georgetown University Hospital, Washington DC

6Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda MD

7Division of Infectious Diseases, Georgetown University Hospital, Washington DC

8University HealthSystem Consortium, Chicago IL

9Department of Health Systems Management, Rush University, Chicago IL

∗∗Corresponding Author: Chanu Rhee, MD, MPH Address: Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute 401 Park Drive, Suite 401 Boston, MA 02215


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


Chest. 2016. doi:10.1016/j.chest.2016.07.010
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Abstract

Background  Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical versus claims data.

Methods  We identified all patients with concurrent blood cultures, antibiotics, and ≥2 consecutive days of vasopressors and all patients with ICD-9 codes for septic shock at 27 academic hospitals from 2005-2014. We compared annual incidence and mortality trends. We reviewed 967 records from 3 hospitals to estimate the accuracy of each method.

Results  Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs. 48.3%, p<0.01), whereas positive predictive value was comparable (83% vs. 89%, p=0.23). Septic shock incidence using clinical criteria rose from 12.8 to 18.6 cases per 1000 hospitalizations (average 4.9% increase/year, 95% CI 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average 0.6% decline/year, 95% CI 0.4%-0.8%). In contrast, septic shock incidence using I0CD-9 codes increased from 6.7 to 19.3 per 1000 hospitalizations (19.8% increase/year, 95% CI 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/year, 95% CI 0.9%-1.6%).

Conclusions  A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated using ICD-9 codes.


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