Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
Crit Care Med. 2013 May;41(5):1167-74. doi: 10.1097/CCM.0b013e31827c09f8.
In 1992, the first consensus definition of severe sepsis was published. Subsequent epidemiologic estimates were collected using administrative data, but ongoing discrepancies in the definition of severe sepsis produced large differences in estimates.
We seek to describe the variations in incidence and mortality of severe sepsis in the United States using four methods of database abstraction. We hypothesized that different methodologies of capturing cases of severe sepsis would result in disparate estimates of incidence and mortality.
DESIGN, SETTING, PARTICIPANTS: Using a nationally representative sample, four previously published methods (Angus et al, Martin et al, Dombrovskiy et al, and Wang et al) were used to gather cases of severe sepsis over a 6-year period (2004-2009). In addition, the use of new International Statistical Classification of Diseases, 9th Edition (ICD-9), sepsis codes was compared with previous methods.
Annual national incidence and in-hospital mortality of severe sepsis.
The average annual incidence varied by as much as 3.5-fold depending on method used and ranged from 894,013 (300/100,000 population) to 3,110,630 (1,031/100,000) using the methods of Dombrovskiy et al and Wang et al, respectively. Average annual increase in the incidence of severe sepsis was similar (13.0% to 13.3%) across all methods. In-hospital mortality ranged from 14.7% to 29.9% using abstraction methods of Wang et al and Dombrovskiy et al. Using all methods, there was a decrease in in-hospital mortality across the 6-year period (35.2% to 25.6% [Dombrovskiy et al] and 17.8% to 12.1% [Wang et al]). Use of ICD-9 sepsis codes more than doubled over the 6-year period (158,722 - 489,632 [995.92 severe sepsis], 131,719 - 303,615 [785.52 septic shock]).
There is substantial variability in incidence and mortality of severe sepsis depending on the method of database abstraction used. A uniform, consistent method is needed for use in national registries to facilitate accurate assessment of clinical interventions and outcome comparisons between hospitals and regions.
1992 年，首次发布了严重脓毒症的共识定义。随后，使用行政数据收集了流行病学估计值，但严重脓毒症的定义持续存在差异，导致估计值存在很大差异。
我们旨在使用四种数据库提取方法描述美国严重脓毒症的发病率和死亡率的变化。我们假设，严重脓毒症病例的不同采集方法将导致发病率和死亡率的估计值存在显著差异。
设计、地点、参与者：使用全国代表性样本，采用四种先前发表的方法（Angus 等人、Martin 等人、Dombrovskiy 等人和 Wang 等人），在 6 年期间（2004-2009 年）收集严重脓毒症病例。此外，还比较了新的国际疾病分类，第 9 版（ICD-9）败血症编码与先前的方法。
严重脓毒症的年度全国发病率和院内死亡率。
根据所使用的方法，平均年发病率差异高达 3.5 倍，使用 Dombrovskiy 等人和 Wang 等人的方法，发病率分别为 300/100,000 人口（894,013 例）和 1,031/100,000 人口（3,110,630 例）。所有方法的严重脓毒症发病率平均年增长率相似（13.0%至 13.3%）。使用 Wang 等人和 Dombrovskiy 等人的提取方法，院内死亡率在 14.7%至 29.9%之间。使用所有方法，6 年期间院内死亡率呈下降趋势（Dombrovskiy 等人的 35.2%至 25.6%和 Wang 等人的 17.8%至 12.1%）。6 年内，ICD-9 败血症编码的使用量增加了一倍多（158,722 至 489,632 [995.92 例严重脓毒症]，131,719 至 303,615 [785.52 例感染性休克]）。
严重脓毒症的发病率和死亡率因数据库提取方法的不同而存在很大差异。需要使用一种统一、一致的方法用于国家登记，以促进对临床干预措施的准确评估以及医院和地区之间的结果比较。
