Objective Sepsis Surveillance Using Electronic Clinical Data

Multiple studies have reported a 2- to 3-fold rise in severe sepsis incidence over the past several decades, accompanied by substantial decreases in case fatality rates.1–6 Almost all of these estimates are based upon claims data, however, and may therefore be biased by increasingly vigilant diagnosis and coding practices.7–9 Indeed, we previously demonstrated that the sensitivity of sepsis codes for capturing the most overt form of sepsis, bacteremia with concurrent vasopressors or lactic acidosis, has increased significantly over time, and that improving documentation of acute organ dysfunction is also likely biasing estimates of changing sepsis severity and burden.10,11 Given the questionable reliability of administrative claims to track severe sepsis incidence and outcomes, we developed a surveillance definition that uses clinical data instead of diagnosis codes and is potentially applicable using electronic health record (EHR) data. Our aim was to characterize the accuracy and stability of this definition over time and compare it with claims-based definitions, using manual medical chart reviews with the international consensus definition as the reference standard. We then estimated and compared changes in severe sepsis incidence and mortality rates using the clinical vs claims-based surveillance definitions.