Benchmarking the Incidence and Mortality of Severe Sepsis in the United States
Benchmarking the Incidence and Mortality of Severe Sepsis in the United States
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DOI：
10.1097/ccm.0b013e31827c09f8
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发表时间：
2013-05-01
影响因子：
8.8
通讯作者：
Carr, Brendan G.
中科院分区：
文献类型：
--
作者：
Gaieski, David F.;Edwards, J. Matthew;Carr, Brendan G.
背景：1992年，发表了第一个关于严重脓毒症的共识定义。随后的流行病学估计是使用行政数据收集的，但在严重败血症定义上的持续差异导致了估计的巨大差异。目的：我们试图用四种数据库抽象方法描述美国严重脓毒症的发病率和死亡率的变化。我们假设捕获严重脓毒症病例的不同方法将导致不同的发病率和死亡率估计。设计、环境、参与者：使用具有全国代表性的样本，采用四种先前发表的方法（Angus等人、Martin等人、Dombrovskiy等人、Wang等人）收集6年（2004-2009年）期间的严重脓毒症病例。此外，使用新的国际疾病统计分类，第9版（ICD-9），败血症代码与以往的方法进行比较。测量：严重败血症的年度全国发病率和住院死亡率。结果：不同方法的年平均发病率差异高达3.5倍，使用Dombrovskiy等和Wang等的方法分别为894,013（300/100,000人口）至3,110,630（1,031/100,000）。在所有方法中，严重脓毒症发生率的平均年增长率相似（13.0%至13.3%）。采用Wang等和Dombrovskiy等的抽象方法，住院死亡率为14.7% ~ 29.9%。使用所有方法，6年期间住院死亡率下降（35.2%至25.6% [Dombrovskiy等]和17.8%至12.1% [Wang等]）。ICD-9脓毒症代码的使用在6年期间增加了一倍多（158,722 - 489,632例[995.92严重脓毒症]，131,719 - 303,615例[785.52脓毒症休克]）。结论：根据数据库提取方法的不同，严重脓毒症的发病率和死亡率存在很大差异。在国家登记中需要使用统一、一致的方法，以促进对临床干预措施的准确评估和医院和地区之间的结果比较。（重症护理医学2013；41:11 167-11 174）
Background: In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates.Objectives: We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality.Design, Setting, Participants: Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods.Measurements: Annual national incidence and in-hospital mortality of severe sepsis.Results: The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]).Conclusion: There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions. (Crit Care Med 2013; 41:1167-1174)