{"indexed":{"date-parts":[[2018,4,13]],"date-time":"2018-04-13T12:02:28Z","timestamp":1523620948698},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"02","content-domain":{"domain":[],"crossmark-restriction":false},"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:sec id=\"S0899823X15002640_abs1\" sec-type=\"general\"><jats:title>OBJECTIVE<\/jats:title><jats:p>To compare the accuracy of surveillance of severe sepsis using electronic health record clinical data vs claims and to compare incidence and mortality trends using both methods.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15002640_abs2\" sec-type=\"general\"><jats:title>DESIGN<\/jats:title><jats:p>We created an electronic health record\u2013based surveillance definition for severe sepsis using clinical indicators of infection (blood culture and antibiotic orders) and concurrent organ dysfunction (vasopressors, mechanical ventilation, and\/or abnormal laboratory values). We reviewed 1,000 randomly selected medical charts to characterize the definition\u2019s accuracy and stability over time compared with a claims-based definition requiring infection and organ dysfunction codes. We compared incidence and mortality trends from 2003\u20132012 using both methods.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15002640_abs3\" sec-type=\"general\"><jats:title>SETTING<\/jats:title><jats:p>Two US academic hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15002640_abs4\" sec-type=\"general\"><jats:title>PATIENTS<\/jats:title><jats:p>Adult inpatients.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15002640_abs5\" sec-type=\"results\"><jats:title>RESULTS<\/jats:title><jats:p>The electronic health record\u2013based clinical surveillance definition had stable and high sensitivity over time (77% in 2003\u20132009 vs 80% in 2012,<jats:italic>P=<\/jats:italic>.58) whereas the sensitivity of claims increased (52% in 2003\u20132009 vs 67% in 2012,<jats:italic>P=<\/jats:italic>.02). Positive predictive values for claims and clinical surveillance definitions were comparable (55% vs 53%,<jats:italic>P=<\/jats:italic>.65) and stable over time. From 2003 to 2012, severe sepsis incidence imputed from claims rose by 72% (95% CI, 57%\u201388%) and absolute mortality declined by 5.4% (95% CI, 4.6%\u20136.7%). In contrast, incidence using the clinical surveillance definition increased by 7.7% (95% CI, \u22121.1% to 17%) and mortality declined by 1.7% (95% CI, 1.1%\u20132.3%).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X15002640_abs6\" sec-type=\"conclusions\"><jats:title>CONCLUSIONS<\/jats:title><jats:p>Sepsis surveillance using clinical data is more sensitive and more stable over time compared with claims and can be done electronically. This may enable more reliable estimates of sepsis burden and trends.<\/jats:p><jats:p><jats:italic>Infect. Control Hosp. Epidemiol.<\/jats:italic>2016;37(2):163\u2013171<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2015.264","type":"article-journal","created":{"date-parts":[[2015,11,3]],"date-time":"2015-11-03T08:50:19Z","timestamp":1446540619000},"page":"163-171","source":"Crossref","is-referenced-by-count":15,"title":"Objective Sepsis Surveillance Using Electronic Clinical Data","prefix":"10.1017","volume":"37","author":[{"given":"Chanu","family":"Rhee","affiliation":[]},{"given":"Sameer","family":"Kadri","affiliation":[]},{"given":"Susan S.","family":"Huang","affiliation":[]},{"given":"Michael V.","family":"Murphy","affiliation":[]},{"given":"Lingling","family":"Li","affiliation":[]},{"given":"Richard","family":"Platt","affiliation":[]},{"given":"Michael","family":"Klompas","affiliation":[]}],"member":"56","published-online":{"date-parts":[[2015,11,3]]},"reference":[{"key":"S0899823X15002640_ref35","DOI":"10.1186\/s13054-015-0847-3","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref20","DOI":"10.1097\/00003246-200107000-00002","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref33","DOI":"10.1097\/CCM.0b013e31827c09f8","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref32","DOI":"10.1097\/CCM.0b013e31827466f1","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref31","DOI":"10.1056\/NEJMra1208623","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref30","DOI":"10.1001\/jama.2014.2637","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref19","DOI":"10.1378\/chest.127.3.942","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref18","DOI":"10.1002\/jhm.2012","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref17","DOI":"10.1186\/cc7157","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref16","DOI":"10.1097\/CCM.0000000000001087","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref15","DOI":"10.1097\/CCM.0b013e3181cb0cdc","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref9","DOI":"10.1056\/NEJMp1400276","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref14","volume":"37","first-page":"483","year":"2011","journal-title":"Jt Comm J Qual Patient Saf","DOI":"10.1016\/S1553-7250(11)37061-4","doi-asserted-by":"crossref"},{"key":"S0899823X15002640_ref8","volume":"43","first-page":"237","year":"2015","journal-title":"Crit Care Med"},{"key":"S0899823X15002640_ref13","DOI":"10.1097\/CCM.0000000000000742","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref7","volume":"307","first-page":"1405","year":"2012","journal-title":"JAMA"},{"key":"S0899823X15002640_ref12","DOI":"10.1097\/CCM.0b013e31827e83af","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref6","DOI":"10.1378\/chest.11-0352","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref11","DOI":"10.1186\/s13054-015-1048-9","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref5","DOI":"10.1097\/CCM.0b013e31825bc92f","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref10","DOI":"10.1093\/cid\/ciu750","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref4","first-page":"1","year":"2011","journal-title":"NCHS Data Brief"},{"key":"S0899823X15002640_ref3","DOI":"10.1097\/CCM.0b013e318232db65","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref2","DOI":"10.1097\/01.CCM.0000261890.41311.E9","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref1","DOI":"10.1056\/NEJMoa022139","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref29","DOI":"10.1001\/jama.1997.03550030074038","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref28","DOI":"10.1016\/j.ajem.2014.06.027","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref27","DOI":"10.1097\/CCM.0b013e31819fcf68","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref26","DOI":"10.1007\/s00134-007-0563-9","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref25","DOI":"10.1016\/j.annemergmed.2004.12.006","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref24","first-page":"552","year":"2002","journal-title":"Proc AMIA Symp"},{"key":"S0899823X15002640_ref23","DOI":"10.1097\/01.CCM.0000050454.01978.3B","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref22","DOI":"10.1016\/j.jbi.2008.08.010","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref21","DOI":"10.1097\/MLR.0b013e318268ac86","doi-asserted-by":"publisher"},{"key":"S0899823X15002640_ref34","DOI":"10.1378\/chest.122.5.1727","doi-asserted-by":"publisher"}],"container-title":"Infection Control & Hospital Epidemiology","original-title":[],"link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X15002640","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2017,6,23]],"date-time":"2017-06-23T22:46:22Z","timestamp":1498257982000},"score":1.0,"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,3]]},"references-count":35,"alternative-id":["S0899823X15002640"],"URL":"http:\/\/dx.doi.org\/10.1017\/ice.2015.264","relation":{"cites":[]},"ISSN":["0899-823X","1559-6834"],"subject":["Microbiology (medical)","Epidemiology","Infectious Diseases"],"container-title-short":"Infect. Control Hosp. Epidemiol."}