TY - JOUR
T1 - Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data
AU - Schwarzkopf, Daniel
AU - Rose, Norman
AU - Fleischmann-Struzek, Carolin
AU - Boden, Beate
AU - Dorow, Heike
AU - Edel, Andreas
AU - Friedrich, Marcus
AU - Gonnert, Falk A.
AU - Götz, Jürgen
AU - Gründling, Matthias
AU - Heim, Markus
AU - Holbeck, Kirill
AU - Jaschinski, Ulrich
AU - Koch, Christian
AU - Künzer, Christian
AU - Le Ngoc, Khanh
AU - Lindau, Simone
AU - Mehlmann, Ngoc B.
AU - Meschede, Jan
AU - Meybohm, Patrick
AU - Ouart, Dominique
AU - Putensen, Christian
AU - Sander, Michael
AU - Schewe, Jens Christian
AU - Schlattmann, Peter
AU - Schmidt, Götz
AU - Schneider, Gerhard
AU - Spies, Claudia
AU - Steinsberger, Ferdinand
AU - Zacharowski, Kai
AU - Zinn, Sebastian
AU - Reinhart, Konrad
N1 - Publisher Copyright:
© The Author(s) 2023.
PY - 2024/4
Y1 - 2024/4
N2 - 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.
AB - 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.
KW - Administrative Claims, Healthcare
KW - Epidemiology
KW - Quality Assurance, Health Care
KW - Sensitivity and specificity
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=85170044804&partnerID=8YFLogxK
U2 - 10.1007/s15010-023-02091-y
DO - 10.1007/s15010-023-02091-y
M3 - Article
AN - SCOPUS:85170044804
SN - 0300-8126
VL - 52
SP - 413
EP - 427
JO - Infection
JF - Infection
IS - 2
ER -