Comparison of Procedure-Based and Diagnosis-Based Identifications of Severe Sepsis and Disseminated Intravascular Coagulation in Administrative Data
Background: Diagnoses recorded in administrative databases have limited utility for accurate identification of severe sepsis and disseminated intravascular coagulation (DIC). We evaluated the performance of alternative identification methods that use procedure records. Methods: We obtained data f...
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| Format: | Article |
| Language: | English |
| Published: |
Japan Epidemiological Association
2016-10-01
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| Series: | Journal of Epidemiology |
| Subjects: | |
| Online Access: | https://www.jstage.jst.go.jp/article/jea/26/10/26_JE20150286/_pdf |
| Summary: | Background: Diagnoses recorded in administrative databases have limited utility for accurate identification of
severe sepsis and disseminated intravascular coagulation (DIC). We evaluated the performance of alternative
identification methods that use procedure records.
Methods: We obtained data for adult patients admitted to intensive care units in three hospitals during a 1-year
period. Severe sepsis and DIC were identified by three means: laboratory data, diagnoses, and procedures. Using
laboratory data as a reference, the sensitivity and specificity of procedure-based methods and diagnosis-based
methods were compared.
Results: Of 595 intensive care unit admissions, 212 (35.6%) and 81 (13.6%) were identified as severe sepsis and
DIC, respectively, using laboratory data. The sensitivity of procedure-based methods for identifying severe sepsis
was 64.2%, and the specificity was 65.3%. Two diagnosis-based methods —the Angus and Martin algorithms—
exhibited sensitivities of 21.7% and 14.6% and specificities of 98.7% and 99.5%, respectively, for severe sepsis. For
DIC, the sensitivity of procedure-based methods was 55.6%, and the specificity was 67.1%, and the sensitivity and
specificity of diagnosis-based methods were 35.8% and 98.2%, respectively.
Conclusions: Procedure-based methods were more sensitive and less specific than diagnosis-based methods in
identifying severe sepsis and DIC. Procedure records could improve disease identification in administrative
databases. |
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| ISSN: | 0917-5040 1349-9092 |