title: Filtering authentic sepsis arising in the ICU using administrative codes coupled to a SIRS screening protocol.
abstract: Using administrative codes and minimal physiologic and laboratory data, we sought a high-specificity identification strategy for patients whose sepsis initially appeared during their ICU stay.
  
  
  
  We studied all patients discharged from an academic hospital between September 1, 2013 and October 31, 2014. Administrative codes and minimal physiologic and laboratory criteria were used to identify patients at high risk of developing the onset of sepsis in the ICU. Two clinicians then independently reviewed the patient record to verify that the screened-in patients appeared to become septic during their ICU admission.
  
  
  
  Clinical chart review verified sepsis in 437/466 ICU stays (93.8%). Of these 437 encounters, only 151 (34.6%) were admitted to the ICU with neither SIRS nor evidence of infection and therefore appeared to become septic during their ICU stay.
  
  
  
  Selected administrative codes coupled to SIRS criteria and applied to patients admitted to ICU can yield up to 94% authentic sepsis patients. However, only 1/3 of patients thus identified appeared to become septic during their ICU stay. Studies that depend on high-intensity monitoring for description of the time course of sepsis require clinician review and verification that sepsis initially appeared during the monitoring period.
authors.affiliation: Critical Care Center, Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United States. Electronic address: sudduth@ohsu.edu.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Sudduth
authors.affiliation: Critical Care Center, Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United States. Electronic address: elizabeth.overton@emory.edu.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Overton
authors.affiliation: Critical Care Center, Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United States. Electronic address: peter.lyu@emoryhealthcare.org.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Lyu
authors.affiliation: Critical Care Center, Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United States. Electronic address: ramzyrimawi@emory.edu.
authors.forename: Ramzy H
authors.initials: RH
authors.lastname: Rimawi
authors.affiliation: Critical Care Center, Emory University School of Medicine, Emory Healthcare, Atlanta, GA, United States. Electronic address: tbuchma@emory.edu.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Buchman
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D059019:Clinical Coding; D003625:Data Collection; D005260:Female; D005845:Georgia; D006760:Hospitalization; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D006278:Medicare; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis*; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*; D016896:Treatment Outcome; D014481:United States
keywords: Administrative codes; Detection; Epidemiology; Intensive care unit; Sepsis; Systemic inflammatory response syndrome