title: Estimating Ten-Year Trends in Septic Shock Incidence and Mortality in United States Academic Medical Centers Using Clinical Data.
abstract: Reports that septic shock incidence is rising and mortality rates declining may be confounded by improving recognition of sepsis and changing coding practices. We compared trends in septic shock incidence and mortality in academic hospitals using clinical vs claims data.
  
  
  
  We identified all patients with concurrent blood cultures, antibiotics, and vasopressors for ≥ two consecutive days, and all patients with International Classification of Diseases, 9th edition (ICD-9) codes for septic shock, at 27 academic hospitals from 2005 to 2014. We compared annual incidence and mortality trends. We reviewed 967 records from three hospitals to estimate the accuracy of each method.
  
  
  
  Of 6.5 million adult hospitalizations, 99,312 (1.5%) were flagged by clinical criteria, 82,350 (1.3%) by ICD-9 codes, and 44,651 (0.7%) by both. Sensitivity for clinical criteria was higher than claims (74.8% vs 48.3%; P < .01), whereas positive predictive value was comparable (83% vs 89%; P = .23). Septic shock incidence, based on clinical criteria, rose from 12.8 to 18.6 cases per 1,000 hospitalizations (average, 4.9% increase/y; 95% CI, 4.0%-5.9%), while mortality declined from 54.9% to 50.7% (average, 0.6% decline/y; 95% CI, 0.4%-0.8%). In contrast, septic shock incidence, based on ICD-9 codes, increased from 6.7 to 19.3 per 1,000 hospitalizations (19.8% increase/y; 95% CI, 16.6%-20.9%), while mortality decreased from 48.3% to 39.3% (1.2% decline/y; 95% CI, 0.9%-1.6%).
  
  
  
  A clinical surveillance definition based on concurrent vasopressors, blood cultures, and antibiotics accurately identifies septic shock hospitalizations and suggests that the incidence of patients receiving treatment for septic shock has risen and mortality rates have fallen, but less dramatically than estimated on the basis of ICD-9 codes.
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD; Department of Medicine, Massachusetts General Hospital, Boston, MA.
authors.forename: Sameer S
authors.initials: SS
authors.lastname: Kadri
authors.affiliation: Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA. Electronic address: crhee1@partners.org.
authors.forename: Chanu
authors.initials: C
authors.lastname: Rhee
authors.affiliation: Department of Internal Medicine, Georgetown University Hospital, Washington, DC; Division of Clinical Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strich
authors.affiliation: Division of Infectious Diseases, Georgetown University Hospital, Washington, DC.
authors.forename: Megan K
authors.initials: MK
authors.lastname: Morales
authors.affiliation: University HealthSystem Consortium, Chicago, IL; Department of Health Systems Management, Rush University, Chicago, IL.
authors.forename: Samuel
authors.initials: S
authors.lastname: Hohmann
authors.affiliation: Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Menchaca
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Suffredini
authors.affiliation: Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Danner
authors.affiliation: Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA; Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA.
authors.forename: Michael
authors.initials: M
authors.lastname: Klompas
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D015331:Cohort Studies; D046508:Culture Techniques / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D011158:Population Growth; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012772:Shock, Septic / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D014662:Vasoconstrictor Agents
keywords: epidemiology; incidence; mortality; sepsis; septic shock; trends