TABLE 3.

Accuracy of Surveillance Definitions Based on Electronic Health Record (EHR) Clinical and Claims Data for Identifying Hospitalizations With Severe Sepsis Determined by Medical Record Review in 2012 vs 2003–2009

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.

^aIndicates statistically significant differences.