Accuracy of International classification of diseases, 10th revision codes for identifying severe sepsis in patients admitted from the emergency department.

OBJECTIVE To determine the accuracy of International classification of diseases, 10th revision, Australian modification (ICD-10-AM) codes in identifying severe sepsis in patients admitted from the emergency department (ED). DESIGN, SETTING AND PARTICIPANTS A retrospective cohort study of ED patients transferred to the intensive care unit of a tertiary hospital within 24 hours of leaving ED, 2000- 2006. MAIN OUTCOME MEASURES Clinical diagnosis of severe sepsis compared with diagnosis-based code (DB-C) categories based on ICD-10-AM codes in the Emergency Department Information Systems (EDIS) and Hospital Morbidity Data System (HMDS); sensitivity, specificity, positive predictive value (PPV) and negative predictive value of these databases. RESULTS In the study period, 1645 patients were transferred to the ICU from the ED, of whom 254 had severe sepsis. Single discharge ICD-10-AM codes recorded in the EDIS and the principal ICD-10-AM codes recorded in the HMDS that fell into D-BC categories for sepsis, pneumonia, viscous perforation, peritonitis, cholecystitis or cholangitis had a PPV of 85.0% (95% CI, 78.4%-91.6%; 96/113) and 88.2% (95%CI, 72.6%-82.6%; 112/127), respectively. The respective sensitivity was 37.8% (95% CI, 31.8%-43.8%) (96/254) and 44.1% (95% CI, 38.0-50.2) (112/254). In contrast, ICD-10-AM codes in the HMDS that code for infection and organ dysfunction had a PPV of 33.5% (95% CI, 30.0%-37.0%; 227/677) and sensitivity of 89.4% (95% CI, 85.6%-93.2%; 227/254). CONCLUSION ICD-10-AM codes recorded in the EDIS or HMD had limited utility for identifying severe sepsis in patients admitted to ICU from the ED.

[1]  D. Pittet,et al.  The natural history of the systemic inflammatory response syndrome (SIRS). A prospective study. , 1995, JAMA.

[2]  D. Mannino,et al.  The epidemiology of sepsis in the United States from 1979 through 2000. , 2003, The New England journal of medicine.

[3]  J. Finn,et al.  A validation study: how effective is the Hospital Morbidity Data as a surveillance tool for heart failure in Western Australia? , 2008, Australian and New Zealand journal of public health.

[4]  R. Bellomo,et al.  Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units , 2004, Intensive Care Medicine.

[5]  V. Sundararajan,et al.  Quality of Diagnosis and Procedure Coding in ICD-10 Administrative Data , 2006, Medical care.

[6]  D. Cooper,et al.  The Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008. , 2008, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[7]  Derek C Angus,et al.  Severe sepsis epidemiology: sampling, selection, and society , 2004, Critical care.

[8]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

[9]  Irwani Ibrahim.  It is time to label sepsis as a public health problem. , 2008, Journal of critical care.

[10]  H. Kelly,et al.  ICD-10 codes are a valid tool for identification of pneumonia in hospitalized patients aged ⩾65 years , 2007, Epidemiology and Infection.

[11]  J. L. Gall,et al.  APACHE II--a severity of disease classification system. , 1986, Critical care medicine.

[12]  R. Bellomo,et al.  Landmark survival as an end-point for trials in critically ill patients – comparison of alternative durations of follow-up: an exploratory analysis , 2009, Critical care.

[13]  Matthew Knuiman,et al.  A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study , 2005, Critical care.

[14]  D. Pittet,et al.  Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock: Incidence, morbidities and outcomes in surgical ICU patients , 1995, Intensive Care Medicine.

[15]  Heinz Schneider,et al.  Economic aspects of severe sepsis: a review of intensive care unit costs, cost of illness and cost effectiveness of therapy. , 2004, PharmacoEconomics.

[16]  J. Finn,et al.  Data Linkage Enables Evaluation of Long-Term Survival after Intensive Care , 2006, Anaesthesia and intensive care.

[17]  F Doyon,et al.  Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. French ICU Group for Severe Sepsis. , 1995, JAMA.

[18]  S. Trzeciak.  National Study of Emergency Department Visits for Sepsis, 1992 to 2001Strehlow MC, Emond SD, Shapiro NI, et al (Stanford Univ, Palo Alto, Calif; Beth Israel Deaconess Med Ctr, Boston; Massachusetts Gen Hosp, Boston) Ann Emerg Med 48:326–331, 2006§ , 2007 .

[19]  Derek C. Angus,et al.  National estimates of severe sepsis in United States emergency departments , 2007, Critical care medicine.

[20]  W. Knaus,et al.  Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. , 1992, Chest.

[21]  S. Dzik.  Early goal-directed therapy in the treatment of severe sepsis and septic shock , 2002 .

[22]  Arise.  The outcome of patients with sepsis and septic shock presenting to emergency departments in Australia and New Zealand. , 2007, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[23]  Duncan Young,et al.  Epidemiology of severe sepsis occurring in the first 24 hrs in intensive care units in England, Wales, and Northern Ireland , 2003, Critical care medicine.

[24]  A. J. Bass,et al.  Validation of linked administrative data on end‐stage renal failure: application of record linkage to a ‘clinical base population’ , 1999, Australian and New Zealand journal of public health.

[25]  I. Seppelt,et al.  The Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock: 2008. An assessment by the Australian and New Zealand Intensive Care Society , 2008, Anaesthesia and intensive care.

[26]  C. Sprung,et al.  Sepsis in European intensive care units: Results of the SOAP study* , 2006, Critical care medicine.

[27]  François Gouin,et al.  Incidence, Risk Factors, and Outcome of Severe Sepsis and Septic Shock in Adults: A Multicenter Prospective Study in Intensive Care Units , 1995 .

[28]  C. Sprung,et al.  Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock 2012 , 2013, Critical care medicine.

[29]  C. Camargo,et al.  National study of emergency department visits for sepsis, 1992 to 2001. , 2006, Annals of emergency medicine.

[30]  G. Clermont,et al.  Epidemiology of severe sepsis in the United States: Analysis of incidence, outcome, and associated costs of care , 2001, Critical care medicine.

[31]  A. J. Bass,et al.  Population‐based linkage of health records in Western Australia: development of a health services research linked database , 1999, Australian and New Zealand journal of public health.

[32]  G. Jelinek,et al.  ECHO: The Western Australian Emergency Care Hospitalisation and Outcome Linked Data Project , 2006, Australian and New Zealand journal of public health.

[33]  S. Yao,et al.  Epidemiology of severe sepsis in critically ill surgical patients in ten university hospitals in China* , 2007, Critical care medicine.

[34]  M. Levy,et al.  Surviving Sepsis Campaign: International guidelines for management of severe sepsis and septic shock: 2008 , 2007, Intensive Care Medicine.

[35]  S. Zanotti-Cavazzoni.  Epidemiology of Sepsis in Victoria, Australia , 2006 .