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Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data

OBJECTIVE: Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also as...

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Autores principales: Jolley, Rachel J, Quan, Hude, Jetté, Nathalie, Sawka, Keri Jo, Diep, Lucy, Goliath, Jade, Roberts, Derek J, Yipp, Bryan G, Doig, Christopher J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691777/
https://www.ncbi.nlm.nih.gov/pubmed/26700284
http://dx.doi.org/10.1136/bmjopen-2015-009487
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author Jolley, Rachel J
Quan, Hude
Jetté, Nathalie
Sawka, Keri Jo
Diep, Lucy
Goliath, Jade
Roberts, Derek J
Yipp, Bryan G
Doig, Christopher J
author_facet Jolley, Rachel J
Quan, Hude
Jetté, Nathalie
Sawka, Keri Jo
Diep, Lucy
Goliath, Jade
Roberts, Derek J
Yipp, Bryan G
Doig, Christopher J
author_sort Jolley, Rachel J
collection PubMed
description OBJECTIVE: Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients. SETTING AND PARTICIPANTS: All adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included. RESEARCH DESIGN: Patient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis. MEASURES: Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Sepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly. CONCLUSIONS: This study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes.
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spelling pubmed-46917772015-12-30 Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data Jolley, Rachel J Quan, Hude Jetté, Nathalie Sawka, Keri Jo Diep, Lucy Goliath, Jade Roberts, Derek J Yipp, Bryan G Doig, Christopher J BMJ Open Intensive Care OBJECTIVE: Administrative health data are important for health services and outcomes research. We optimised and validated in intensive care unit (ICU) patients an International Classification of Disease (ICD)-coded case definition for sepsis, and compared this with an existing definition. We also assessed the definition's performance in non-ICU (ward) patients. SETTING AND PARTICIPANTS: All adults (aged ≥18 years) admitted to a multisystem ICU with general medicosurgical ICU care from one of three tertiary care centres in the Calgary region in Alberta, Canada, between 1 January 2009 and 31 December 2012 were included. RESEARCH DESIGN: Patient medical records were randomly selected and linked to the discharge abstract database. In ICU patients, we validated the Canadian Institute for Health Information (CIHI) ICD-10-CA (Canadian Revision)-coded definition for sepsis and severe sepsis against a reference standard medical chart review, and optimised this algorithm through examination of other conditions apparent in sepsis. MEASURES: Sensitivity (Sn), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Sepsis was present in 604 of 1001 ICU patients (60.4%). The CIHI ICD-10-CA-coded definition for sepsis had Sn (46.4%), Sp (98.7%), PPV (98.2%) and NPV (54.7%); and for severe sepsis had Sn (47.2%), Sp (97.5%), PPV (95.3%) and NPV (63.2%). The optimised ICD-coded algorithm for sepsis increased Sn by 25.5% and NPV by 11.9% with slightly lowered Sp (85.4%) and PPV (88.2%). For severe sepsis both Sn (65.1%) and NPV (70.1%) increased, while Sp (88.2%) and PPV (85.6%) decreased slightly. CONCLUSIONS: This study demonstrates that sepsis is highly undercoded in administrative data, thus under-ascertaining the true incidence of sepsis. The optimised ICD-coded definition has a higher validity with higher Sn and should be preferentially considered if used for surveillance purposes. BMJ Publishing Group 2015-12-22 /pmc/articles/PMC4691777/ /pubmed/26700284 http://dx.doi.org/10.1136/bmjopen-2015-009487 Text en Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/ This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Intensive Care
Jolley, Rachel J
Quan, Hude
Jetté, Nathalie
Sawka, Keri Jo
Diep, Lucy
Goliath, Jade
Roberts, Derek J
Yipp, Bryan G
Doig, Christopher J
Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title_full Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title_fullStr Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title_full_unstemmed Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title_short Validation and optimisation of an ICD-10-coded case definition for sepsis using administrative health data
title_sort validation and optimisation of an icd-10-coded case definition for sepsis using administrative health data
topic Intensive Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4691777/
https://www.ncbi.nlm.nih.gov/pubmed/26700284
http://dx.doi.org/10.1136/bmjopen-2015-009487
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