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Schwarzkopf D, Rose N, Fleischmann-Struzek C, Boden B, Dorow H, Edel A, Friedrich M, Gonnert FA, Götz J, Gründling M, Heim M, Holbeck K, Jaschinski U, Koch C, Künzer C, Le Ngoc K, Lindau S, Mehlmann NB, Meschede J, Meybohm P, Ouart D, Putensen C, Sander M, Schewe JC, Schlattmann P, Schmidt G, Schneider G, Spies C, Steinsberger F, Zacharowski K, Zinn S, Reinhart K. Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data. Infection 2024; 52:413-427. [PMID: 37684496 PMCID: PMC10954942 DOI: 10.1007/s15010-023-02091-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023]
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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Affiliation(s)
- Daniel Schwarzkopf
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
| | - Norman Rose
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 103, 07747, Jena, Germany
| | - Carolin Fleischmann-Struzek
- Institute of Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 103, 07747, Jena, Germany
| | - Beate Boden
- Department of Internal Medicine II-Intensive Care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756, Detmold, Germany
| | - Heike Dorow
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Andreas Edel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Friedrich
- Berlin Institute of Health, Visiting Professor for the Stiftung Charité, Anna-Louisa-Karsch-Str. 2, 10178, Berlin, Germany
| | - Falk A Gonnert
- Department of Anaesthesiology and Intensive Care Medicine, SRH Wald-Klinikum, Straße des Friedens 122, 07548, Gera, Germany
| | - Jürgen Götz
- Department of Internal Medicine II-Intensive Care, Klinikum Lippe GmbH, Röntgenstraße 18, 32756, Detmold, Germany
| | - Matthias Gründling
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Markus Heim
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Ismaninger Straße 22, 81675, Munich, Germany
| | - Kirill Holbeck
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Ismaninger Straße 22, 81675, Munich, Germany
| | - Ulrich Jaschinski
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Christian Koch
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, UKGM, Justus-Liebig University Gießen, Rudolf-Buchheim-Straße 7, 35392, Giessen, Germany
| | - Christian Künzer
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Khanh Le Ngoc
- Department of Anaesthesiology and Intensive Care Medicine, SRH Wald-Klinikum, Straße des Friedens 122, 07548, Gera, Germany
| | - Simone Lindau
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Ngoc B Mehlmann
- Department of Anaesthesiology and Surgical Intensive Care Medicine, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Jan Meschede
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Ismaninger Straße 22, 81675, Munich, Germany
| | - Patrick Meybohm
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Oberduerrbacher Straße 6, 97080, Würzburg, Germany
| | - Dominique Ouart
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Christian Putensen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Michael Sander
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, UKGM, Justus-Liebig University Gießen, Rudolf-Buchheim-Straße 7, 35392, Giessen, Germany
| | - Jens-Christian Schewe
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
- Department of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, University Medical Centre Rostock, Schillingallee 35, 18057, Rostock, Germany
| | - Peter Schlattmann
- Institute for Medical Statistics, Computer Science and Data Science, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Götz Schmidt
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, UKGM, Justus-Liebig University Gießen, Rudolf-Buchheim-Straße 7, 35392, Giessen, Germany
| | - Gerhard Schneider
- Department of Anesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Ismaninger Straße 22, 81675, Munich, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Ferdinand Steinsberger
- Department of Anesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Gießen, UKGM, Justus-Liebig University Gießen, Rudolf-Buchheim-Straße 7, 35392, Giessen, Germany
| | - Kai Zacharowski
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Sebastian Zinn
- Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, Goethe University, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Konrad Reinhart
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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