Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data

败血症 医学 流行病学 诊断代码 入射(几何) 编码(社会科学) 急诊医学 回顾性队列研究 重症监护医学 内科学 统计 环境卫生 人口 数学 光学 物理
作者
Daniel Schwarzkopf,Norman Rose,Carolin Fleischmann,Barry P. Boden,Heike Dorow,Andreas Edel,Marcus Friedrich,Falk A. Gonnert,Jürgen Götz,Matthias Gründling,Markus Heim,Kirill Holbeck,Ulrich Jaschinski,Christian Koch,Christian Künzer,Khanh Le Ngoc,Simone Lindau,Ngoc B. Mehlmann,J. Meschede,Patrick Meybohm,Dominique Ouart,Christian Putensen,Michael Sander,Jens-Christian Schewe,Peter Schlattmann,Götz Schmidt,Gerhard Schneider,Claudia Spies,Ferdinand Steinsberger,Kai Zacharowski,Sebastian Zinn,Konrad Reinhart
出处
期刊:Infection [Springer Science+Business Media]
标识
DOI:10.1007/s15010-023-02091-y
摘要

Abstract Purpose Timely and accurate data on the epidemiology of sepsis are essential to inform policy decisions and research priorities. We aimed to investigate the validity of inpatient administrative health data (IAHD) for surveillance and quality assurance of sepsis care. Methods We conducted a retrospective validation study in a disproportional stratified random sample of 10,334 inpatient cases of age ≥ 15 years treated in 2015–2017 in ten German hospitals. The accuracy of coding of sepsis and risk factors for mortality in IAHD was assessed compared to reference standard diagnoses obtained by a chart review. Hospital-level risk-adjusted mortality of sepsis as calculated from IAHD information was compared to mortality calculated from chart review information. Results ICD-coding of sepsis in IAHD showed high positive predictive value (76.9–85.7% depending on sepsis definition), but low sensitivity (26.8–38%), which led to an underestimation of sepsis incidence (1.4% vs. 3.3% for severe sepsis-1). Not naming sepsis in the chart was strongly associated with under-coding of sepsis. The frequency of correctly naming sepsis and ICD-coding of sepsis varied strongly between hospitals (range of sensitivity of naming: 29–71.7%, of ICD-diagnosis: 10.7–58.5%). Risk-adjusted mortality of sepsis per hospital calculated from coding in IAHD showed no substantial correlation to reference standard risk-adjusted mortality ( r = 0.09). Conclusion Due to the under-coding of sepsis in IAHD, previous epidemiological studies underestimated the burden of sepsis in Germany. There is a large variability between hospitals in accuracy of diagnosing and coding of sepsis. Therefore, IAHD alone is not suited to assess quality of sepsis care.
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