Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis.
Temporal trends in the systemic inflammatory response syndrome, sepsis, and medical coding of sepsis.
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DOI：
10.1186/s12871-015-0148-z
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发表时间：
2015-11-24
影响因子：
2.2
通讯作者：
Marschall J
中科院分区：
文献类型：
--
作者：
Thomas BS;Jafarzadeh SR;Warren DK;McCormick S;Fraser VJ;Marschall J
最近使用行政索赔数据的报告表明，社区和医院发生的脓毒症的发病率正在增加。这是否反映了流行病学的变化，更有效的诊断方法，或医生文件和医疗编码实践的变化尚不清楚。我们使用密苏里州圣路易斯Barnes-Jewish医院收治的成人患者的行政索赔数据和患者水平的临床数据进行了一项2008年至2012年的时间趋势研究。时间趋势和年度百分比变化估计使用自回归综合移动平均误差的回归模型。我们分析了5年研究期间的62，261例住院患者。“任何SIRS”（即，在住院期间的单个日历日的SIRS）和“多日SIRS”（即，SIRS在3个或更多个日历日），这两者都使用患者水平的数据，以及败血症的医学编码（即，ICD-9-CM出院诊断代码995.91、995.92或785.52）分别在35.3%、17.3%和3.3%的入院患者中出现。在研究期间，因败血症住院的发生率每年增加9.7%（95%CI：6.1，13.4），而患者数据定义的“任何SIRS”事件减少1.8%（95%CI：-3.2，-0.5），“多日SIRS”没有显著变化。临床定义的脓毒症（定义为SIRS+菌血症）和严重脓毒症（定义为SIRS+低血压和菌血症）每年以5.7%（95%CI：−9.0，−2.4）和8.6%（95%CI：−4.4，−12.6）的统计学显著率下降。全因死亡率、SIRS死亡率、SIRS和临床定义的脓毒症病死率在研究期间没有显著变化。然而，根据ICD-9-CM编码，脓毒症死亡率每年增加8.8%（95%CI：1.9，16.2）。根据ICD-9-CM代码定义的脓毒症发生率和脓毒症死亡率稳步增加，而SIRS或临床定义的脓毒症未伴随增加。我们的研究结果强调需要制定策略，将临床患者水平的数据与管理数据相结合，以得出更准确的脓毒症流行病学结论。
Recent reports using administrative claims data suggest the incidence of community- and hospital-onset sepsis is increasing. Whether this reflects changing epidemiology, more effective diagnostic methods, or changes in physician documentation and medical coding practices is unclear. We performed a temporal-trend study from 2008 to 2012 using administrative claims data and patient-level clinical data of adult patients admitted to Barnes-Jewish Hospital in St. Louis, Missouri. Temporal-trend and annual percent change were estimated using regression models with autoregressive integrated moving average errors. We analyzed 62,261 inpatient admissions during the 5-year study period. ‘Any SIRS’ (i.e., SIRS on a single calendar day during the hospitalization) and ‘multi-day SIRS’ (i.e., SIRS on 3 or more calendar days), which both use patient-level data, and medical coding for sepsis (i.e., ICD-9-CM discharge diagnosis codes 995.91, 995.92, or 785.52) were present in 35.3 %, 17.3 %, and 3.3 % of admissions, respectively. The incidence of admissions coded for sepsis increased 9.7 % (95 % CI: 6.1, 13.4) per year, while the patient data-defined events of ‘any SIRS’ decreased by 1.8 % (95 % CI: −3.2, −0.5) and ‘multi-day SIRS’ did not change significantly over the study period. Clinically-defined sepsis (defined as SIRS plus bacteremia) and severe sepsis (defined as SIRS plus hypotension and bacteremia) decreased at statistically significant rates of 5.7 % (95 % CI: −9.0, −2.4) and 8.6 % (95 % CI: −4.4, −12.6) annually. All-cause mortality, SIRS mortality, and SIRS and clinically-defined sepsis case fatality did not change significantly during the study period. Sepsis mortality, based on ICD-9-CM codes, however, increased by 8.8 % (95 % CI: 1.9, 16.2) annually. The incidence of sepsis, defined by ICD-9-CM codes, and sepsis mortality increased steadily without a concomitant increase in SIRS or clinically-defined sepsis. Our results highlight the need to develop strategies to integrate clinical patient-level data with administrative data to draw more accurate conclusions about the epidemiology of sepsis.