Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania; Departments of Critical Care and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Surg Res. 2022 Jul;275:327-335. doi: 10.1016/j.jss.2022.02.036. Epub 2022 Mar 21.
Unlike antibiotic and perfusion support, guidelines for sepsis source control lack high-quality evidence and are ungraded. Internally valid administrative data methods are needed to identify cases representing source control procedures to evaluate outcomes.
Over five modified Delphi rounds, two independent reviewers identified Current Procedural Terminology (CPT) codes pertinent to source control. In each round, codes with perfect agreement were retained or excluded, whereas disagreements were reviewed by the panelists. Manual review of 400 patient records meeting Sepsis-3 criteria (2010-2017) clinically adjudicated which encounters included source control procedures (gold standard). The performance of consensus codes was compared with the gold standard to assess sensitivity, specificity, predictive values, and likelihood ratios.
Of 5752 CPT codes, 609 consensus codes represented source control procedures. Of 400 hospitalizations for sepsis, 39 (9.8%; 95% confidence interval [CI] 7.0%-13.1%) underwent gold standard source control procedures and 29 (7.3%; 95% CI 4.9-10.3%) consensus code-defined source control procedures. Thirty consensus codes were identified (20.0% gastrointestinal/intraabdominal, 10.0% genitourinary, 13.3% hepatopancreatobiliary, 23.3% orthopedic/cranial, 23.3% soft tissue, and 10.0% intrathoracic), which had 61.5% (95% CI 44.6%-76.6%) sensitivity, 98.6% (95% CI 96.8%-99.6%) specificity, 83.2% (95% CI 66.6%-92.4%) positive, and 95.9% (95% CI 93.9%-97.2%) negative predictive values. With pretest probability at sample prevalence, an identified consensus code had a posttest probability of 83.0% (95% CI 66.0%-92.0%), whereas consensus code absence had a probability of 4.0% (95% CI 3.0-6.0) for undergoing a source control procedure.
Using modified Delphi methodology, we created and validated CPT codes identifying source control procedures, providing a framework for evaluation of the surgical care of patients with sepsis.
与抗生素和灌注支持不同，脓毒症源控制指南缺乏高质量的证据，并且未进行分级。需要内部有效的行政数据方法来识别代表源控制程序的病例，以评估结果。
经过五轮改良德尔菲法，两名独立审查员确定了与源控制相关的当前操作术语 (CPT) 代码。在每一轮中，完全一致的代码被保留或排除，而有分歧的代码则由专家组审查。对符合脓毒症-3 标准（2010-2017 年）的 400 例患者记录进行了手工审查，临床判定哪些就诊包括源控制程序（金标准）。将共识代码的性能与金标准进行比较，以评估敏感性、特异性、预测值和似然比。
在 5752 个 CPT 代码中，有 609 个共识代码代表源控制程序。在 400 例脓毒症住院患者中，有 39 例（9.8%；95%置信区间 [CI] 7.0%-13.1%）接受了金标准源控制程序，29 例（7.3%；95% CI 4.9%-10.3%）接受了共识代码定义的源控制程序。确定了 30 个共识代码（20.0%胃肠道/腹腔内、10.0%泌尿生殖道、13.3%肝胆胰、23.3%骨科/颅、23.3%软组织和 10.0%胸内），其敏感性为 61.5%（95% CI 44.6%-76.6%），特异性为 98.6%（95% CI 96.8%-99.6%），阳性预测值为 83.2%（95% CI 66.6%-92.4%），阴性预测值为 95.9%（95% CI 93.9%-97.2%）。在样本患病率的预测试概率下，确定的共识代码的后测试概率为 83.0%（95% CI 66.0%-92.0%），而共识代码不存在的概率为 4.0%（95% CI 3.0%-6.0%）接受源控制程序。
使用改良 Delphi 方法，我们创建并验证了识别源控制程序的 CPT 代码，为评估脓毒症患者的手术治疗提供了框架。
