Marginal Causal Effect of Year of Hospitalization on Sepsis Diagnosis
Section snippets
Purpose
To quantify the coinciding improvement in the diagnosis and documentation of sepsis (hereafter ‘diagnosis'), as indicated by ICD-9-CM coding in administrative data, by estimating changes in the probability of diagnosis in recent years.
Methods
We conducted a retrospective cohort study of 98,267 hospitalizations in 66,208 unique patients who met systemic inflammatory response syndrome (SIRS) criteria at a tertiary-care center from 2008-2012. We estimated the marginal causal effect of year of hospitalization on diagnosis using a g-computation approach, which uses a counterfactual framework relating unobserved outcomes to hypothesized unobserved exposures, following mixed-effects logistic regression modeling of sepsis diagnosis among
Results
The observed frequency of sepsis diagnosis in SIRS hospitalizations were 1,339 (6.8%), 1,401 (7.1%), 1,592 (8.0%), 1,789 (9.0%) and 1,994 (10.4%) in the years from 2008 to 2012, respectively. In addition to year of hospitalization, intensive care unit admission (odds ratio [OR] = 5.5; 95% confidence interval [CI]: 4.8, 5.3) and number of blood cultures per hospitalization (OR = 1.3; 95% CI: 1.2, 1.3) were associated with diagnosis after adjustment for demographics and Charlson comorbidity
Conclusions
In patients with identical risk factors and covariates, sepsis diagnosis and its documentation improved significantly in recent years and contributed to an apparent increase in sepsis incidence.