Consensus Current Procedural Terminology Code Definition of Source Control for Sepsis.
Consensus Current Procedural Terminology Code Definition of Source Control for Sepsis.
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DOI：
10.1016/j.jss.2022.02.036
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发表时间：
2022-07
影响因子：
2.2
通讯作者：
Reitz, Katherine M.
中科院分区：
文献类型：
--
作者：
Li, Shimena R.;Handzel, Robert M.;Tonetti, Daniel;Kennedy, Jason;Shapiro, Katherine;Rosengart, Matthew R.;Hall, Daniel E.;Seymour, Christopher;Tzeng, Edith;Reitz, Katherine M.
与抗生素和灌注支持不同，脓毒症源头控制指南缺乏高质量的证据，并且未分级。需要内部有效的行政数据方法来确定代表源控制程序的案例，以评估结果。经过五轮修改的德尔菲，两个独立的评审员确定了与源代码控制相关的当前程序术语（CPT）代码。在每一轮中，完全一致的代码被保留或排除，而不一致的代码由小组成员审查。手动审查400例符合脓毒症-3标准（2010-2017年）的患者记录，这些患者记录经临床裁定，包括源控制程序（金标准）。将共识编码的性能与金标准进行比较，以评估灵敏度、特异性、预测值和似然比。在5，752个CPT代码中，609个共识代码代表源代码控制程序。在400例因败血症住院的患者中，39例（9.8%; 95%CI 7.0-13.1%）接受了金标准源控制程序，29例（7.3%; 95%CI 4.9-10.3%）接受了共识代码定义的源控制程序。确定了30个共识代码（20.0%胃肠道/腹腔内，10.0%泌尿生殖系统，13.3%肝胆胰，23.3%骨科/颅骨，23.3%软组织，10.0%胸腔内），其中61.5%（95%CI 44.6-76.6%）的敏感性、98.6%（95%CI 96.8-99.6%）的特异性、83.2%（95%CI 66.6-92.4%）的阳性预测值和95.9%（95%CI 93.9-97.2%）的阴性预测值。在样本流行率的前测概率下，识别出的共识代码的后测概率为83.0%（95%CI 66.0-92.0%），而共识代码缺失的概率为4.0%（95%CI 3.0-6.0）。使用修改后的德尔菲方法，我们创建和验证CPT代码识别源控制程序，提供了一个框架，评估脓毒症患者的外科护理。
Unlike antibiotic and perfusion support, guidelines for sepsis source control lack high-quality evidence and are ungraded. Internally valid administrative data methods are needed to identify cases representing source control procedures to evaluate outcomes. Over five modified Delphi Rounds, two independent reviewers identified Current Procedural Terminology (CPT) codes pertinent to source control. In each Round, codes with perfect agreement were retained or excluded, while disagreements were reviewed by the panelists. Manual review of 400 patient records meeting Sepsis-3 criteria (2010–2017) clinically adjudicated which encounters included source control procedures (gold standard). Performance of consensus codes were compared to the gold standard to assess sensitivity, specificity, predictive values, and likelihood ratios. Of 5,752 CPT codes, 609 consensus codes represented source control procedures. Of 400 hospitalizations for sepsis, 39 (9.8%; 95%CI 7.0–13.1%) underwent gold standard source control procedures and 29 (7.3%; 95%CI 4.9–10.3%) consensus code defined source control procedures. Thirty consensus codes were identified (20.0% gastrointestinal/intra-abdominal, 10.0% genitourinary, 13.3% hepatopancreatobiliary, 23.3% orthopedic/cranial, 23.3% soft tissue, 10.0% intra-thoracic) which had 61.5% (95%CI 44.6–76.6%) sensitivity, 98.6% (95%CI 96.8–99.6%) specificity, 83.2% (95%CI 66.6–92.4%) positive and 95.9% (95%CI 93.9–97.2%) negative predictive values. With pretest probability at sample prevalence, an identified consensus code had a posttest probability of 83.0% (95%CI 66.0–92.0%) while consensus code absence had a probability of 4.0% (95%CI 3.0–6.0) for undergoing a source control procedure. Using modified Delphi methodology, we created and validated CPT codes identifying source control procedures, providing a framework for evaluation of the surgical care of patients with sepsis.
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DOI：
10.1001/jama.2016.0288
发表时间：
2016-02-23
期刊：
JAMA
影响因子：
--
作者：
Seymour CW;Liu VX;Iwashyna TJ;Brunkhorst FM;Rea TD;Scherag A;Rubenfeld G;Kahn JM;Shankar-Hari M;Singer M;Deutschman CS;Escobar GJ;Angus DC
通讯作者：
Angus DC
DOI：
10.1186/cc13755
发表时间：
2014-03-03
期刊：
Critical care (London, England)
影响因子：
--
作者：
Bloos F;Thomas-Rüddel D;Rüddel H;Engel C;Schwarzkopf D;Marshall JC;Harbarth S;Simon P;Riessen R;Keh D;Dey K;Weiß M;Toussaint S;Schädler D;Weyland A;Ragaller M;Schwarzkopf K;Eiche J;Kuhnle G;Hoyer H;Hartog C;Kaisers U;Reinhart K;MEDUSA Study Group
通讯作者：
MEDUSA Study Group
DOI：
10.1056/nejmoa1411162
发表时间：
2015-05-21
期刊：
The New England journal of medicine
影响因子：
--
作者：
Sawyer RG;Claridge JA;Nathens AB;Rotstein OD;Duane TM;Evans HL;Cook CH;O'Neill PJ;Mazuski JE;Askari R;Wilson MA;Napolitano LM;Namias N;Miller PR;Dellinger EP;Watson CM;Coimbra R;Dent DL;Lowry SF;Cocanour CS;West MA;Banton KL;Cheadle WG;Lipsett PA;Guidry CA;Popovsky K;STOP-IT Trial Investigators
通讯作者：
STOP-IT Trial Investigators
影响因子：
3.4
作者：
Connolly, Ian David;Johnson, Eli;Li, Gordon
通讯作者：
Li, Gordon
影响因子：
38.9
作者：
Boyer, Alexandre;Vargas, Frederic;Gruson, Didier
通讯作者：
Gruson, Didier