Rhee C, et al. - The US national incidence of sepsis and trends utilizing detailed clinical data from the electronic health record (EHR) systems of diverse hospitals was estimated in this study. In clinical data from 409 hospitals, sepsis was present in 6% of adult hospitalizations, and in contrast to claims-based analyses, neither the incidence of sepsis nor the combined outcome of death or discharge to hospice changed significantly between 2009-2014. The outcomes also suggest that EHR-based clinical data provide more objective estimates than claims-based data for sepsis surveillance.

Methods

• For this research, they designed a retrospective cohort study.
• This was the study of adult patients admitted to 409 academic, community, and federal hospitals from 2009-2014.
• In this study, sepsis was identified utilizing clinical indicators of presumed infection and concurrent acute organ dysfunction, adapting Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria for objective and consistent EHR-based surveillance.

Results

• A total of 173690 sepsis cases (mean age, 66.5 [SD, 15.5] y; 77660 [42.4%] women) were recognized utilizing clinical criteria among 2901019 adults admitted to study hospitals in 2014 (6.0% incidence).
• Of these, 26061 (15.0%) died in the hospital and 10731 (6.2%) were discharged to hospice.
• From 2009-2014, sepsis incidence utilizing clinical criteria was stable (+0.6% relative change/y [95% CI, -2.3% to 3.5%], P = .67) whereas incidence per claims increased (+10.3%/y [95% CI, 7.2% to 13.3%], P < .001).
• In-hospital mortality utilizing clinical criteria declined (-3.3%/y [95% CI, -5.6% to -1.0%], P = .004), but no important change was seen in the combined outcome of death or discharge to hospice (-1.3%/y [95% CI, -3.2% to 0.6%], P = .19).
• In contrast, mortality utilizing claims declined significantly (-7.0%/y [95% CI, -8.8% to -5.2%], P < .001), as did death or discharge to hospice (-4.5%/y [95% CI, -6.1% to -2.8%], P < .001).
• Clinical criteria were more sensitive in identifying sepsis than claims (69.7% [95% CI, 52.9% to 92.0%] vs 32.3% [95% CI, 24.4% to 43.0%], P < .001), with comparable positive predictive value (70.4% [95% CI, 64.0% to 76.8%] vs 75.2% [95% CI, 69.8% to 80.6%], P = .23).