What is the best method for estimating the burden of severe sepsis in the United States?

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• 作者：Tara Lagu ; Michael B. Rothberg ; Meng-Shiou Shieh ; Penelope S. Pekow ; Jay S. Steingrub ; Peter K. Lindenauer
• 关键词：Sepsis ; Severe sepsis ; Mortality ; Costs
• 刊名：Journal of Critical Care
• 出版年：2012
• 出版时间：August, 2012
• 年：2012
• 卷：27
• 期：4
• 页码：414.e1-414.e9
• 全文大小：200 K

文摘

Purpose

The aim of the study was to compare estimates of hospitalizations, outcomes, and costs produced by 2 approaches for defining severe sepsis.

Methods

We used the Nationwide Inpatient Sample to study adults hospitalized in the United States in 2007. We defined severe sepsis using 2 previously published algorithms: (1) the presence of a principal or secondary diagnosis of septicemia combined with organ dysfunction or (2) the presence of a principal or secondary diagnosis of septicemia or another infection (eg, pneumonia) combined with organ dysfunction. For each approach, we calculated the weighted frequency of hospitalizations, population-based mortality rates, and geometric mean costs.

Results

A total of 719?099 (SD, 16?676) hospitalizations had a diagnosis of septicemia and a diagnosis of organ dysfunction. A total of 2.5 million hospitalizations were recorded, with a diagnosis code for either septicemia or infection combined with a diagnosis code for organ dysfunction. Hospitalizations without a diagnosis code for septicemia had lower rates of respiratory failure (35 % vs 51 % , P < .001) or shock (20 % vs 46 % , P < .001), lower in-hospital mortality (8 % vs 29 % , P < .001), and lower mean costs.

Conclusions

An approach that requires a diagnosis code for septicemia and a diagnosis code for organ dysfunction yields estimates of disease burden and outcomes that are more consistent with chart-based studies.