Tracking septic shock using claims not as accurate as using clinical data, study shows

Investigators compared the effectiveness of tracking septic shock cases via claims data and via clinical data in a study published in CHEST. They found that clinical data-based surveillance is more reliable.

The researchers examined data from 27 academic hospitals between 2005 and 2014. They identified cases of septic shock using the two different methods. For claims-based surveillance, they examined cases with septic shock-related ICD-9 billing codes. For clinical data-based surveillance, they looked at cases where patients received concurrent vasopressors, blood culture orders and antibiotics.

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The study shows that the accuracy of tracking septic shock was higher with clinical data-based surveillance as compared to claims-based surveillance (74.8 percent versus 48.3 percent).

Researchers found that when using clinical data, septic shock cases rose from 12.8 to 18.6 per 1,000 hospitalizations, while mortality decreased from 54.9 percent to 50.7 percent. However, when using claims data, the jump was much larger — from 6.7 to 19.3 cases per 1,000 hospitalizations, while mortality decreased from 48.3 percent to 39.3 percent.
 
"The incidence of patients with discharge codes or clinical markers indicative of treated septic shock steadily rose during the 10-year surveillance period, and in-hospital mortality for this population declined," said co-lead investigator Chanu Rhee, MD, of the department of population medicine at Boston-based Harvard Medical School/Harvard Pilgrim Health Care Institute. "The magnitude of these trends was considerably less when using clinical data compared with claims codes. Clinician record reviews suggested that clinical surveillance definitions for septic shock provide greater sensitivity and comparable positive predictive value than billing codes."

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