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Sepsis Is Underreported in Swedish Intensive Care Units: A Retrospective Observational Multicentre Study

Lengquist, Maria LU ; Lundberg, Oscar LU ; Spångfors, Martin LU ; Annborn, Martin LU ; Levin, Helena LU ; Friberg, Hans LU and Frigyesi, Attila LU (2020) In Acta Anaesthesiologica Scandinavica p.1167-1167
Abstract
Background
Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis‐3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported.

Methods
Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis‐3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry.

Results
Of 5990 adult ICU patients, 28% fulfilled the Sepsis‐3 criteria on... (More)
Background
Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis‐3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported.

Methods
Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis‐3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry.

Results
Of 5990 adult ICU patients, 28% fulfilled the Sepsis‐3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis‐3 patients, 38% met the septic shock criteria. The Sepsis‐3 in‐hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU‐treated sepsis was 81 cases per 100 000 person‐years. One in four had a positive blood culture, and 44% were culture negative.

Conclusion
This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis‐3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Acta Anaesthesiologica Scandinavica
pages
1167 - 1167
publisher
Wiley-Blackwell
external identifiers
  • scopus:85086565754
  • pmid:32463121
ISSN
0001-5172
DOI
10.1111/aas.13647
project
Identification and classification of sepsis in the intensive care unit
language
English
LU publication?
yes
id
e3b3501c-0eea-4783-ab1f-2ec312476692
date added to LUP
2020-06-16 19:46:03
date last changed
2021-01-19 01:21:43
@article{e3b3501c-0eea-4783-ab1f-2ec312476692,
  abstract     = {Background<br/>Sepsis is a common indication for admission to the intensive care unit (ICU). Since definitions vary across studies, comparisons of prevalence and outcomes have been challenging. We aimed to compare sepsis according to ICU discharge codes with sepsis according to Sepsis‐3 criteria and to investigate the epidemiology of sepsis in the ICU. We hypothesized that sepsis using discharge codes is underreported.<br/><br/>Methods<br/>Adult ICU admissions to four ICUs in Sweden between 2015 and 2017 were screened for sepsis according to the Sepsis‐3 criteria. Medical records were reviewed and data extracted from the Swedish Intensive Care Registry.<br/><br/>Results<br/>Of 5990 adult ICU patients, 28% fulfilled the Sepsis‐3 criteria on admission, but only 31% of them had sepsis as the registered main diagnosis at ICU discharge. Of the 1654 Sepsis‐3 patients, 38% met the septic shock criteria. The Sepsis‐3 in‐hospital mortality was 26% compared to 33% in patients with septic shock. The incidence rate for ICU‐treated sepsis was 81 cases per 100 000 person‐years. One in four had a positive blood culture, and 44% were culture negative.<br/><br/>Conclusion<br/>This large Swedish multicentre study showed that 28% of adult ICU patients fulfilled the Sepsis‐3 criteria, but only one third of them had sepsis according to ICU discharge codes. We could confirm our hypothesis, that sepsis is severely underreported in Swedish ICUs, and we conclude that discharge codes should not be used for quality control or research purposes.},
  author       = {Lengquist, Maria and Lundberg, Oscar and Spångfors, Martin and Annborn, Martin and Levin, Helena and Friberg, Hans and Frigyesi, Attila},
  issn         = {0001-5172},
  language     = {eng},
  month        = {05},
  pages        = {1167--1167},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Anaesthesiologica Scandinavica},
  title        = {Sepsis Is Underreported in Swedish Intensive Care Units: A Retrospective Observational Multicentre Study},
  url          = {http://dx.doi.org/10.1111/aas.13647},
  doi          = {10.1111/aas.13647},
  year         = {2020},
}