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Retrospective study to examine hospital coding and clinical features of maternal sepsis-related morbidity
Abstract Number: S-71
Abstract Type: Original Research
Introduction: The quality of hospital coding for maternal sepsis, severe sepsis and septic shock is not well described. In addition, Systemic Inflammatory Response Syndrome criteria can overlap with normal physiologic parameters of pregnancy, therefore the clinical diagnosis of maternal sepsis can prove challenging. (1, 2) The aims of the study were (i) to determine the positive predictive value (PPV)s of ICD-9 billing codes for maternal sepsis, severe sepsis and septic shock, and (ii) to examine key clinical features, laboratory indices and outcomes for these morbidities.
Methods and Materials: In this IRB-approved retrospective study we examined medical records of hospitalized women identified using ICD-9 codes for maternal sepsis, severe sepsis and septic shock between 2007–2013 in a single tertiary obstetric center. The diagnoses of sepsis, severe sepsis and septic shock were confirmed using criteria defined by the International Sepsis Definitions Conference. (2) We recorded vital signs and laboratory data at the time of hospital admission and at the time of diagnosis of each septic condition.
Results: We initially identified 190 women with ICD-9 codes for the septic morbidities. After examining medical records, only 35 (18%) women met criteria for a clinical diagnosis of sepsis, severe sepsis or septic shock. The PPVs of billing coding were low: sepsis = 15%; severe sepsis = 10%; and septic shock = 24%. Maternal vital signs and laboratory data documented at admission and at clinical diagnosis are presented in the Table. The mean (SD) times from admission to diagnosis were: sepsis = 108 (192) hours; severe sepsis = 212 (345) hours; septic shock = 64 (51) hours. No women died of sepsis during the study period.
Discussion: At the time of admission and clinical diagnosis, we observed considerable heterogeneity in the maternal vital signs and laboratory indices of women who met current criteria for sepsis, severe sepsis or septic shock. Using current sepsis criteria, the low PPVs in our study suggest that ICD-9 coding errors for these conditions are highly prevalent. Population-wide studies are needed to establish specific diagnostic and early detection criteria for sepsis in the obstetric setting, and to validate the accuracy of ICD-9 codes for maternal sepsis.
1) Crit Care Med 2003;31:1250-1256
2) Anesth Analg 2013;117:944-50