August 20, 2019

Clinical Data Analysis Finds Sepsis Incidence and Outcome of Death or Discharge to Hospice Remain Steady

According to a recent study published in JAMA, incidence and mortality rates of sepsis in the United States appear to have remained constant in recent years based on clinical data, despite the higher incidence and lower mortality suggested by claims-based data.

"Despite its importance, reliably measuring sepsis incidence and trends is challenging," the study authors write. As sepsis awareness increases and sepsis coding practices change, they voice concerns about the reliability of claims-based trends.

“…neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009–2014.”
-Chanu Rhee, MD, MPH, Harvard Medical School

The retrospective cohort study looked at claims-based data and clinical electronic health record (EHR) data from patients 20 years or older admitted to 409 US hospitals from 2009 to 2014. Researchers identified sepsis cases from EHR data using an adapted version of the Third International Consensus Definitions for Sepsis and Septic Shock, with sepsis defined as presumed infection alongside signs of acute organ dysfunction.

Clinical vs. Claims-Based Trends from 2009-2014

  • Sepsis Identification. Investigators found that EHR clinical criteria were more sensitive in identifying sepsis than claims-based methodology (69.7% vs 32.3%).
  • Sepsis Incidence. During the study period of 2009-2014, sepsis incidence from EHR data remained stable, with a marginal increase of .6% per year, while incidence using claims data increased significantly by 10.3% per year.
  • In-Hospital Mortality. Using EHR data, in-hospital mortality decreased slightly by 3.3% per year, while claims data showed a significant declining mortality rate of 7%.
  • Combined Outcome of Death or Discharge to Hospice. When analyzing EHR data, no major change was found to the combined outcome of death or discharge to hospice, with a marginal decrease of 1.3%. By comparison, analysis using claims data found a significant decline of 4.5% per year.

‘A Major Public Health Problem’

"Reliable sepsis surveillance is essential given its high burden," the authors state. “Sepsis is a major public health problem. It is among the most expensive conditions treated in US hospitals and a leading cause of death.”

In light of the fact that claims data "can be biased by changing diagnosis and coding practices over time,” these findings suggest that EHR-based data may show more accurate sepsis trends than claims data. Hence, the authors conclude that based on clinical data, sepsis incidence and mortality seem to have remained fairly constant from 2009-2014.

Source: "Incidence and Trends of Sepsis in US Hospitals Using Clinical vs. Claims Data, 2009-2014," JAMA; October 3, 2019; DOI: 10.1001/jama.2017.13836. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, et al; for the CDC Prevention Epicenter Program; Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston; Department of Medicine, Brigham and Women's Hospital, Boston; and Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta.

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