Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data
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Published:2023-09-09
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Volume:
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ISSN:0300-8126
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Container-title:Infection
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language:en
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Short-container-title:Infection
Author:
Schwarzkopf DanielORCID, Rose NormanORCID, Fleischmann-Struzek CarolinORCID, Boden Beate, Dorow Heike, Edel AndreasORCID, Friedrich Marcus, Gonnert Falk A., Götz Jürgen, Gründling Matthias, Heim MarkusORCID, Holbeck Kirill, Jaschinski Ulrich, Koch Christian, Künzer ChristianORCID, Le Ngoc Khanh, Lindau Simone, Mehlmann Ngoc B., Meschede Jan, Meybohm PatrickORCID, Ouart Dominique, Putensen Christian, Sander MichaelORCID, Schewe Jens-ChristianORCID, Schlattmann Peter, Schmidt GötzORCID, Schneider GerhardORCID, Spies ClaudiaORCID, Steinsberger Ferdinand, Zacharowski KaiORCID, Zinn SebastianORCID, Reinhart Konrad
Abstract
Abstract
Purpose
Timely and accurate data on the epidemiology of sepsis are essential to inform policy decisions and research priorities. We aimed to investigate the validity of inpatient administrative health data (IAHD) for surveillance and quality assurance of sepsis care.
Methods
We conducted a retrospective validation study in a disproportional stratified random sample of 10,334 inpatient cases of age ≥ 15 years treated in 2015–2017 in ten German hospitals. The accuracy of coding of sepsis and risk factors for mortality in IAHD was assessed compared to reference standard diagnoses obtained by a chart review. Hospital-level risk-adjusted mortality of sepsis as calculated from IAHD information was compared to mortality calculated from chart review information.
Results
ICD-coding of sepsis in IAHD showed high positive predictive value (76.9–85.7% depending on sepsis definition), but low sensitivity (26.8–38%), which led to an underestimation of sepsis incidence (1.4% vs. 3.3% for severe sepsis-1). Not naming sepsis in the chart was strongly associated with under-coding of sepsis. The frequency of correctly naming sepsis and ICD-coding of sepsis varied strongly between hospitals (range of sensitivity of naming: 29–71.7%, of ICD-diagnosis: 10.7–58.5%). Risk-adjusted mortality of sepsis per hospital calculated from coding in IAHD showed no substantial correlation to reference standard risk-adjusted mortality (r = 0.09).
Conclusion
Due to the under-coding of sepsis in IAHD, previous epidemiological studies underestimated the burden of sepsis in Germany. There is a large variability between hospitals in accuracy of diagnosing and coding of sepsis. Therefore, IAHD alone is not suited to assess quality of sepsis care.
Funder
German Innovations Fund of the Federal Joint Committee Universitätsklinikum Jena
Publisher
Springer Science and Business Media LLC
Subject
Infectious Diseases,Microbiology (medical),General Medicine
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