TABLE 3.
Variable | Sensitivity
|
Positive predictive value
|
||||
---|---|---|---|---|---|---|
2003–2009 n (%) [95% CI] | 2012 n (%) [95% CI] | P value | 2003–2009 n (%) [95% CI] | 2012 n (%) [95% CI] | P value | |
EHR clinical surveillance definitions | ||||||
Primary definition: | 99/128 (77.3) [69.1–84.3] | 74/92 (80.4) [70.9–88.0] | .58 | 99/194 (51.0) [43.8–58.3] | 74/140 (52.9) [44.2–61.3] | .74 |
Blood culture + antibiotic ≥ 4 days + (vasopressor or mechanical ventilation × 2 days or creatinine increase ≥ 0.5 or INR >1.5 or total bilirubin ≥2.0 or platelet count <100) within ±2 days | ||||||
Definition with lactate: | 102/128 (79.7) [71.7–86.3] | 79/92 (85.9) [77.1–92.3] | .24 | 102/197 (51.8) [44.6–58.9] | 79/146 (54.1) [45.7–62.4] | .67 |
Blood culture + antibiotic ≥ 4 days + (vasopressor or lactate ≥ 2.0 or mechanical ventilation × 2 days or creatinine increase ≥ 0.5 or INR >1.5 or total bilirubin ≥2.0 or platelet count <100) within ±2 days | ||||||
Simplified definition: | 95/128 (74.2) [65.7–81.5] | 65/92 (70.7) [60.2–79.7] | .56 | 95/153 (62.1) [53.9–69.8] | 65/106 (61.3) [51.4–70.6] | .90 |
Blood culture + antibiotic ≥ 4 days + (vasopressor or mechanical ventilation × 2 days or creatinine increase ≥ 0.5) within ±2 days | ||||||
Claims surveillance definitions | ||||||
Modified Angus codes: | 66/128 (51.6) [42.6–60.5] | 62/92 (67.4) [56.8–76.8] | .02a | 67/128 (52.3) [43.3–61.2] | 62/112 (55.4) [45.7–64.8] | .64 |
1 of 1,286 infection ICD-9-CM codes and 1 of 13 organ dysfunction codes, or explicit severe sepsis (995.92) or septic shock (785.52) code | ||||||
Explicit severe sepsis or septic shock codes: | 12/128 (9.4) [4.9–15.8] | 24/92 (26.1) [17.5–36.3] | <.01a | 13/13 (100) [75.3–100] | 24/25 (96.0) [79.7–99.9] | .47 |
995.92 or 785.52 ICD-9-CM code |
NOTE. ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; INR, international normalized ratio.
Indicates statistically significant differences.