Balamuth Fran, Weiss Scott L, Hall Matt, Neuman Mark I, Scott Halden, Brady Patrick W, Paul Raina, Farris Reid W D, McClead Richard, Centkowski Sierra, Baumer-Mouradian Shannon, Weiser Jason, Hayes Katie, Shah Samir S, Alpern Elizabeth R
Children's Hospital of Philadelphia, Philadelphia, PA.
Children's Hospital Association, Overland Park, KS.
J Pediatr. 2015 Dec;167(6):1295-300.e4. doi: 10.1016/j.jpeds.2015.09.027. Epub 2015 Oct 23.
To evaluate accuracy of 2 established administrative methods of identifying children with sepsis using a medical record review reference standard.
Multicenter retrospective study at 6 US children's hospitals. Subjects were children >60 days to <19 years of age and identified in 4 groups based on International Classification of Diseases, Ninth Revision, Clinical Modification codes: (1) severe sepsis/septic shock (sepsis codes); (2) infection plus organ dysfunction (combination codes); (3) subjects without codes for infection, organ dysfunction, or severe sepsis; and (4) infection but not severe sepsis or organ dysfunction. Combination codes were allowed, but not required within the sepsis codes group. We determined the presence of reference standard severe sepsis according to consensus criteria. Logistic regression was performed to determine whether addition of codes for sepsis therapies improved case identification.
A total of 130 out of 432 subjects met reference SD of severe sepsis. Sepsis codes had sensitivity 73% (95% CI 70-86), specificity 92% (95% CI 87-95), and positive predictive value 79% (95% CI 70-86). Combination codes had sensitivity 15% (95% CI 9-22), specificity 71% (95% CI 65-76), and positive predictive value 18% (95% CI 11-27). Slight improvements in model characteristics were observed when codes for vasoactive medications and endotracheal intubation were added to sepsis codes (c-statistic 0.83 vs 0.87, P = .008).
Sepsis specific International Classification of Diseases, Ninth Revision, Clinical Modification codes identify pediatric patients with severe sepsis in administrative data more accurately than a combination of codes for infection plus organ dysfunction.
使用病历审查参考标准评估两种既定的识别脓毒症患儿的管理方法的准确性。
在美国6家儿童医院进行的多中心回顾性研究。研究对象为年龄大于60天至小于19岁的儿童，根据《国际疾病分类，第九版，临床修订本》编码分为4组：（1）严重脓毒症/脓毒性休克（脓毒症编码）；（2）感染加器官功能障碍（组合编码）；（3）无感染、器官功能障碍或严重脓毒症编码的受试者；（4）感染但无严重脓毒症或器官功能障碍。脓毒症编码组允许使用组合编码，但不是必需的。我们根据共识标准确定参考标准严重脓毒症的存在。进行逻辑回归以确定添加脓毒症治疗编码是否能改善病例识别。
432名受试者中共有130名符合严重脓毒症的参考标准。脓毒症编码的敏感性为73%（95%可信区间70 - 86），特异性为92%（95%可信区间87 - 95），阳性预测值为79%（95%可信区间70 - 86）。组合编码的敏感性为15%（95%可信区间9 - 22），特异性为71%（95%可信区间65 - 76），阳性预测值为18%（95%可信区间11 - 27）。当将血管活性药物和气管插管编码添加到脓毒症编码中时，模型特征有轻微改善（c统计量0.83对0.87，P = 0.008）。
特定于脓毒症的《国际疾病分类，第九版，临床修订本》编码比感染加器官功能障碍编码组合能更准确地在管理数据中识别患有严重脓毒症的儿科患者。
