Sepsis surveillance from administrative data in the absence of a perfect verification.
- Jafarzadeh SR Department of Medicine, Washington University School of Medicine, St. Louis, MO. Electronic address: srjafarz@bu.edu.
- Thomas BS Department of Medicine, Washington University School of Medicine, St. Louis, MO; Department of Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu.
- Gill J Division of Biostatistics, Washington University School of Medicine, St. Louis, MO; Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO.
- Fraser VJ Department of Medicine, Washington University School of Medicine, St. Louis, MO.
- Marschall J Department of Medicine, Washington University School of Medicine, St. Louis, MO; Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
- Warren DK Department of Medicine, Washington University School of Medicine, St. Louis, MO.
- 2016-09-08
Published in:
- Annals of epidemiology. - 2016
Bayesian estimation
No reference standard
Prevalence
Sensitivity
Sepsis
Specificity
Surveillance
Bayes Theorem
Databases, Factual
Female
Health Surveys
Hospital Mortality
Hospitalization
Humans
International Classification of Diseases
Male
Prevalence
Public Health
Retrospective Studies
Risk Assessment
Sepsis
Survival Analysis
United States
English
PURPOSE
Past studies of sepsis epidemiology did not address misclassification bias due to imperfect verification of sepsis detection methods to estimate the true prevalence.
METHODS
We examined 273,126 hospitalizations from 2008 to 2012 at a tertiary-care center to develop surveillance-aimed sepsis detection criteria, based on the presence of the sepsis-explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.92 or 785.52), blood culture orders, and antibiotics administration. We used Bayesian multinomial latent class models to estimate the true prevalence of sepsis, while adjusting for the imperfect sensitivity and specificity and the conditional dependence among the individual criteria.
RESULTS
The apparent annual prevalence of sepsis hospitalizations based on explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes were 1.5%, 1.4%, 1.6%, 2.2%, and 2.5% for the years 2008 to 2012. Bayesian posterior estimates for the true prevalence of sepsis suggested that it remained stable from 2008, 19.2% (95% credible interval [CI]: 17.9%, 22.9%), to 2012, 17.8% (95% CI: 16.8%, 20.2%). The sensitivity of sepsis-explicit codes, however, increased from 7.6% (95% CI: 6.4%, 8.4%) in 2008 to 13.8% (95% CI: 12.2%, 14.9%) in 2012.
CONCLUSIONS
The true prevalence of sepsis remained high, but stable despite an increase in the sensitivity of sepsis-explicit codes in administrative data.
Past studies of sepsis epidemiology did not address misclassification bias due to imperfect verification of sepsis detection methods to estimate the true prevalence.
METHODS
We examined 273,126 hospitalizations from 2008 to 2012 at a tertiary-care center to develop surveillance-aimed sepsis detection criteria, based on the presence of the sepsis-explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.92 or 785.52), blood culture orders, and antibiotics administration. We used Bayesian multinomial latent class models to estimate the true prevalence of sepsis, while adjusting for the imperfect sensitivity and specificity and the conditional dependence among the individual criteria.
RESULTS
The apparent annual prevalence of sepsis hospitalizations based on explicit International Classification of Diseases, Ninth Revision, Clinical Modification codes were 1.5%, 1.4%, 1.6%, 2.2%, and 2.5% for the years 2008 to 2012. Bayesian posterior estimates for the true prevalence of sepsis suggested that it remained stable from 2008, 19.2% (95% credible interval [CI]: 17.9%, 22.9%), to 2012, 17.8% (95% CI: 16.8%, 20.2%). The sensitivity of sepsis-explicit codes, however, increased from 7.6% (95% CI: 6.4%, 8.4%) in 2008 to 13.8% (95% CI: 12.2%, 14.9%) in 2012.
CONCLUSIONS
The true prevalence of sepsis remained high, but stable despite an increase in the sensitivity of sepsis-explicit codes in administrative data.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.annepidem.2016.08.002
- PMID 27600804
- Persistent URL
- https://sonar.ch/global/documents/278601
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