To further explore these issues, in this issue of CHEST, Kadri and colleagues analyzed 6.5 million adult hospitalizations from 2005 to 2014 at 27 academic hospitals to calculated trends in septic shock incidence and mortality over time. Because their data set contained detailed records of each hospitalization, including treatments administered during the hospital stay, the authors developed a non-ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification)-code-based clinical algorithm for identifying septic shock cases. In addition to a blood culture order and antibiotic administration, their clinical surveillance definition required that patients receive vasopressor support for two or more consecutive days. The authors then compared septic shock incidence and mortality derived from this clinical definition with those derived from the septic shock ICD-9-CM billing code. Finally, they validated each definition by performing chart reviews on a subset of 1,000 patients to calculate sensitivity and specificity of each.