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Original Research: Critical Care Medicine |

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

Sameer S. Kadri, MD; 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

Drs Kadri and Rhee are co-first authors who contributed equally to this manuscript.

FUNDING/SUPPORT: This research was funded in part by National Institutes of Health Intramural funds. Dr Rhee received support from the National Institutes of Health [T32 AI007061].

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

bDepartment of Medicine, Massachusetts General Hospital, Boston, MA

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

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

eDepartment of Internal Medicine, Georgetown University Hospital, Washington, DC

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

gDivision of Infectious Diseases, Georgetown University Hospital, Washington, DC

hUniversity HealthSystem Consortium, Chicago, IL

iDepartment of Health Systems Management, Rush University, Chicago, IL

CORRESPONDENCE TO: Chanu Rhee, MD, MPH, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA 02215


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


Chest. 2017;151(2):278-285. doi:10.1016/j.chest.2016.07.010
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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 vs claims data.

Methods  We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three 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 < .01), whereas positive predictive value was comparable (83% vs 89%; P = .23). Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 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 on the basis of ICD-9 codes.

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