Dear Drs. Nuttall and Hess,
Being one of many outcomes researchers to have undertaken to identify sepsis and severe sepsis retrospectively using administrative hospital data, may I humbly recommend a review of a paper we published in Advances in Sepsis in 2005? Our attempt to improve identification of patients retrospectively took place as uptake of ICD-9-CM codes 995.9x was expanding but not yet in full force. Just as now, the coding of sepsis and severe sepsis using the newer ICD-9-CM codes was more often found as non-primary codes. For our study, we began with the method suggested earlier by Dr. Angus and colleagues and then presented the results of using certain methodological options to improve identification when one had additional data elements at hand, such as evidence of support for organ dysfunction like use of vasopressors, mechanical ventilation, renal replacement therapy, and can identify the timing of these interventions within the hospital stay. I offer the following reference in case it prompts others to develop better, more currently relevant methods: Challenges of Identification of Severe Sepsis in Administrative Data and Feasibility of an Alternative Method. Adv Sepsis 2005; 5(1): 11-18. (http://www.advancesinsepsis.com/details.aspx?itemid=4163 ). I would be interested in your impressions of our prior feasibility study and your suggestions for currently relevant improvements. Best regards, Frank R. Ernst, PharmD, MS Principal, Premier Research Services Premier healthcare alliance, Charlotte, NC 28277 704.816.5092 tel / fax :: [email protected] <mailto:[email protected]> From: [email protected] [mailto:[email protected]] On Behalf Of Stuart Nuttall Sent: Thursday, April 12, 2012 4:07 PM To: Hess, Dr. Donald Cc: '[email protected]' Subject: Re: [Sepsis Groups] Sepsis & severe sepsis: A primary or secondary diagnosis? Hi Dr Hess, I would certainly agree although appreciate there may be UK/US differences I've been involved in conducting the College of Emergency Medicine Sepsis Audit for our ED this spring. Trying to identify the patients retrospectively through coding (either hospital or ED coding systems) failed to generate any meaningful data. In my opinion, given the current coding systems in use, prospective identification of these patients using a screening tool in the ED may be more reliable. This is then retained when the patient leaves the ED. These patients can then be audited. I'm aware that for this method patients will still slip though the net and the diagnosis may become more apparent once they have hit the ward but it does seem to be an improvement on just using coding. I think I remember someone mentioning on this list last year that they chase up all patients through the ED (possibly hospital) who had blood cultures or raised WCC's to try and ensure capture of as many patients as possible - more thorough but more time consuming I guess. Would be interested to hear what other departments do. Regards Dr Stuart Nuttall Consultant in Emergency Medicine Leeds Teaching Hospitals. On 12 Apr 2012, at 13:09, Hess, Dr. Donald wrote: After reading a recent article in the April 4, 2012 issue of JAMA (Lindauer PK, et al, Association of Diagnostic Coding With Trends in Hospitalizations and Mortality of Patients With Pneumonia, 2003-2009 - http://jama.ama-assn.org/content/307/13/1405.full), I decided to look at my institution's administrative data regarding the number of hospitalizations in the past 4 years that were coded with the ICD9# for either sepsis or severe sepsis as the primary diagnosis. There were none. Zero. I have long suspected that one obstacle to diagnosing sepsis or severe sepsis is that most physicians (and perhaps coders, too) regard it as a secondary diagnosis. That sepsis is always secondary to something else...not a primary diagnosis that represents a final common pathway due to a number of different causes. There are likely a number of other cognitive factors related to the avoidance of diagnosing sepsis and severe sepsis as a primary diagnosis. But evidently physicians & coders at other institutions are doing it. I look forward to your comments. Regards, Dr. Don Hess _______________________________________________ Sepsisgroups mailing list [email protected]<mailto:[email protected]> http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org ----------------------------------------- ***Note:The information contained in this message may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify the Sender immediately by replying to the message and deleting it from your computer. Thank you. Premier Inc.
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