Faculty Collaboration Database

Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes. J Pediatr 2015 Dec;167(6):1295-300.e4

Date

10/17/2015

Pubmed ID

26470685

Pubmed Central ID

PMC4662908

DOI

10.1016/j.jpeds.2015.09.027

Scopus ID

2-s2.0-84951080610 (requires institutional sign-in at Scopus site)   40 Citations

Abstract

OBJECTIVES: To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard.

STUDY DESIGN: Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification.

RESULTS: A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008).

CONCLUSIONS: Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction.

Author List

Balamuth F, Weiss SL, Hall M, Neuman MI, Scott H, Brady PW, Paul R, Farris RW, McClead R, Centkowski S, Baumer-Mouradian S, Weiser J, Hayes K, Shah SS, Alpern ER

Author

Shannon H. Baumer-Mouradian MD Assistant Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Child
Child, Preschool
Female
Humans
Infant
International Classification of Diseases
Male
Predictive Value of Tests
Retrospective Studies
Sensitivity and Specificity
Sepsis
Shock, Septic
United States
Young Adult