title: Outcomes and Resource Use of Sepsis-associated Stays by Presence on Admission, Severity, and Hospital Type.
abstract: OBJECTIVE
  To establish a baseline for the incidence of sepsis by severity and presence on admission in acute care hospital settings before implementation of a broad sepsis screening and response initiative.
  
  
  METHODS
  A retrospective cohort study using hospital discharge abstracts of 5672 patients, aged 18 years and above, with sepsis-associated stays between February 2012 and January 2013 at an academic medical center and 5 community hospitals in Texas.
  
  
  RESULTS
  Sepsis was present on admission in almost 85% of cases and acquired in-hospital in the remainder. The overall inpatient death rate was 17.2%, but was higher in hospital-acquired sepsis (38.6%, medical; 29.2%, surgical) and Stages 2 (17.6%) and 3 (36.4%) compared with Stage 1 (5.9%). Patients treated at the academic medical center had a higher death rate (22.5% vs. 15.1%, P<0.001) and were more costly ($68,050±184,541 vs. $19,498±31,506, P<0.001) versus community hospitals.
  
  
  CONCLUSIONS
  Greater emphasis is needed on public awareness of sepsis and the detection of sepsis in the prehospitalization and early hospitalization period. Hospital characteristics and case mix should be accounted for in cross-hospital comparisons of sepsis outcomes and costs.
authors.affiliation: Departments of *Surgery, Center for Outcomes Research †Anesthesia-Critical Care, Houston, Methodist Research Institute, Houston Methodist Hospital, Houston, TX.
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Jones
authors.forename: Carol M
authors.initials: CM
authors.lastname: Ashton
authors.forename: Lisa B
authors.initials: LB
authors.lastname: Kiehne
authors.forename: Juan C
authors.initials: JC
authors.lastname: Nicolas
authors.forename: Alexis L
authors.initials: AL
authors.lastname: Rose
authors.forename: Beverly A
authors.initials: BA
authors.lastname: Shirkey
authors.forename: Faisal
authors.initials: F
authors.lastname: Masud
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
mesh_terms: D000046:Academic Medical Centers / Q000191:economics / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017714:Community-Acquired Infections / Q000191:economics / Q000453:epidemiology; D003365:Costs and Cost Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology; D003953:Diagnosis-Related Groups; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006764:Hospitals, Community / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012189:Retrospective Studies; D018805:Sepsis / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index