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. Author manuscript; available in PMC: 2016 Feb 5.
Published in final edited form as: Infect Control Hosp Epidemiol. 2015 Nov 3;37(2):163–171. doi: 10.1017/ice.2015.264

TABLE 4.

Reasons for False-Negatives and False-Positives for Surveillance Definitions Relative to Severe Sepsis Determined by Medical Record Review

False-negatives False-positives
EHR clinical surveillance definition N=47a (of 220 chart review-confirmed severe sepsis cases) N= 162a (of 334 EHR definition-positive cases)

  • Sepsis-induced hypotension without vasopressors or other organ dysfunction (n =22)

  • Sepsis episode not captured by EHR antibiotic criteria (n =18):

    • Antibiotics not given on each day for ≥4 day course (n= 6)

    • Did not meet required ≥4 day antibiotic course duration (n =4)

    • Parenteral antibiotic given was not a “new” agent (n =4)

    • Antibiotic administration not captured by EHR (n= 2)

    • Only given oral antibiotics (n =1)

    • Not given antibiotics due to being made comfort care (n =1)

  • Lactate ≥2.0 mmol as sole manifestation of organ dysfunction (n =4)

  • EHR rule for baseline organ dysfunction not consistent with reviewer’s assessment (n =4)

  • Sepsis-induced organ dysfunction that occurred outside ±2 day infection window (n =2)

  • No evidence of infection despite blood culture order and course of antibiotics (n =33)

  • Infection present, but organ dysfunction flagged by definition deemed not to be attributable to sepsis (n =129):

    • Creatinine rise (n= 46)

    • Thrombocytopenia (n =44)

    • Vasopressors (n =25)

    • Mechanical ventilation (n= 24)

    • Bilirubin rise (n =20)

    • INR rise (n= 14)
Claims (modified Angus codes) N=91a (of 220 chart review-confirmed severe sepsis cases) N= 111a (of 240 Angus claims-positive cases)

  • Not coded for infection (n =33)

  • Coded for infection but not coded for sepsis-induced organ dysfunction (n = 56):

  • Hypotension or shock (n= 42)

    • Acute kidney failure (n =24)

    • Thrombocytopenia (n =3)

    • Respiratory failure (n =2)

    • Liver dysfunction (n= 2)

  • Lactate as sole manifestation of sepsis-induced organ dysfunction so not captured by coding scheme (n =2)

  • Coded for organ dysfunction that was deemed not to be attributable to sepsis (n =111):

    • Acute kidney failure (n =53)

    • Ventilator use (n =22)

    • Hypotension or shock (n =20)

    • Thrombocytopenia (n =17)

    • Delirium/encephalopathy (n =12)

    • Liver dysfunction (n =3)

    • Coagulopathy (n =1)

NOTE. EHR, electronic health record; INR, international normalized ratio.

a

Numbers in each cell do not necessarily add up to total N because several cases had multiple reasons for false-negative or false-positive status.