title: Benchmarking the incidence and mortality of severe sepsis in the United States.
abstract: BACKGROUND
  In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates.
  
  
  OBJECTIVE
  We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality.
  
  
  METHODS
  Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods.
  
  
  METHODS
  Annual national incidence and in-hospital mortality of severe sepsis.
  
  
  RESULTS
  The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]).
  
  
  CONCLUSIONS
  There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions.
authors: Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. gaieskid@uphs.upenn.edu
authors: David F
authors: DF
authors: Gaieski
authors: J Matthew
authors: JM
authors: Edwards
authors: Michael J
authors: MJ
authors: Kallan
authors: Brendan G
authors: BG
authors: Carr
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002423:Cause of Death; D015331:Cohort Studies; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D017678:Sex Distribution; D012772:Shock, Septic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D014481:United States / Q000453:epidemiology; D055815:Young Adult