title: Identifying Pediatric Severe Sepsis and Septic Shock: Accuracy of Diagnosis Codes.
abstract: OBJECTIVE
  To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard.
  
  
  METHODS
  Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification.
  
  
  RESULTS
  A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008).
  
  
  CONCLUSIONS
  Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Fran
authors.initials: F
authors.lastname: Balamuth
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: Weiss
authors.affiliation: Children's Hospital Association, Overland Park, KS.
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.affiliation: Boston Children's Hospital, Boston, MA.
authors.forename: Mark I
authors.initials: MI
authors.lastname: Neuman
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Halden
authors.initials: H
authors.lastname: Scott
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Brady
authors.affiliation: Wake Forest Baptist Medical Center, Wake Forest, NC.
authors.forename: Raina
authors.initials: R
authors.lastname: Paul
authors.affiliation: Children's Hospital Seattle, Seattle, WA.
authors.forename: Reid W D
authors.initials: RW
authors.lastname: Farris
authors.affiliation: Nationwide Children's Hospital, Columbus, OH.
authors.forename: Richard
authors.initials: R
authors.lastname: McClead
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Sierra
authors.initials: S
authors.lastname: Centkowski
authors.affiliation: Children's Hospital Colorado, Aurora, CO.
authors.forename: Shannon
authors.initials: S
authors.lastname: Baumer-Mouradian
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Jason
authors.initials: J
authors.lastname: Weiser
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA.
authors.forename: Katie
authors.initials: K
authors.lastname: Hayes
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Samir S
authors.initials: SS
authors.lastname: Shah
authors.affiliation: Lurie Children's Hospital of Chicago, Chicago, IL.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Alpern
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D038801:International Classification of Diseases; D008297:Male; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D012772:Shock, Septic / Q000175:diagnosis*; D014481:United States; D055815:Young Adult