Sensitivity of ICD coding for sepsis in children-a population-based study

Olga Endrich; Karen Triep; Luregn J Schlapbach; Klara M Posfay-Barbe; Ulrich Heininger; Eric Giannoni; Martin Stocker; Anita Niederer-Loher; Christian R Kahlert; Giancarlo Natalucci; Christa Relly; Thomas Riedel; Christoph Aebi; Christoph Berger; Philipp K A Agyeman; Swiss Pediatric Sepsis Study

doi:10.1007/s44253-023-00006-1

Sensitivity of ICD coding for sepsis in children-a population-based study

Intensive Care Med Paediatr Neonatal. 2023;1(1):5. doi: 10.1007/s44253-023-00006-1. Epub 2023 Jun 13.

Authors

Olga Endrich^{1

2}, Karen Triep², Luregn J Schlapbach^{3

4}, Klara M Posfay-Barbe⁵, Ulrich Heininger⁶, Eric Giannoni⁷, Martin Stocker⁸, Anita Niederer-Loher⁹, Christian R Kahlert⁹, Giancarlo Natalucci¹⁰, Christa Relly¹¹, Thomas Riedel^{12

13}, Christoph Aebi¹², Christoph Berger¹¹, Philipp K A Agyeman¹²; Swiss Pediatric Sepsis Study

Collaborators

Swiss Pediatric Sepsis Study:
Walter Bär, Sara Bernhard-Stirnemann, Paul Hasters, Gabriel Konetzny, Antonio Leone

Affiliations

¹ Bern, Switzerland Department of Clinical Chemistry, Inselspital, Bern University Hospital, University of Bern.
² Bern, Switzerland Medical Directorate, Inselspital, Bern University Hospital, University of Bern.
³ Zurich, Switzerland Department of Intensive Care and Neonatology, and Children's Research Center, University Children's Hospital Zurich.
⁴ Brisbane, Australia Child Health Research Center, University of Queensland.
⁵ Geneva, Switzerland Pediatric Infectious Diseases Unit, Children's Hospital of Geneva, University Hospitals of Geneva.
⁶ Basel, Switzerland Infectious Diseases and Vaccinology, University of Basel Children's Hospital.
⁷ Lausanne, Switzerland Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne.
⁸ Lucerne, Switzerland Children's Hospital Lucerne.
⁹ St. Gallen, Switzerland Children's Hospital of Eastern Switzerland St. Gallen.
¹⁰ Zurich, Switzerland Family Larsson-Rosenquist Foundation Centre for Neurodevelopment, Growth and Nutrition of the Newborn, Department of Neonatology, University Hospital Zurich.
¹¹ Zurich, Switzerland Division of Infectious Diseases and Hospital Epidemiology, Children's Research Center, University Children's Hospital Zurich.
¹² Bern, Switzerland Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern.
¹³ Chur, Switzerland Department of Pediatrics, Cantonal Hospital Graubuenden.

Abstract

Background: International Classification of Diseases 10th edition (ICD-10) is widely used to describe the burden of disease.

Aim: To describe how well ICD-10 coding captures sepsis in children admitted to the hospital with blood culture-proven bacterial or fungal infection and systemic inflammatory response syndrome.

Methods: Secondary analysis of a population-based, multicenter, prospective cohort study on children with blood culture-proven sepsis of nine tertiary pediatric hospitals in Switzerland. We compared the agreement of validated study data on sepsis criteria with ICD-10 coding abstraction obtained at the participating hospitals.

Results: We analyzed 998 hospital admissions of children with blood culture-proven sepsis. The sensitivity of ICD-10 coding abstraction was 60% (95%-CI 57-63) for sepsis; 35% (95%-CI 31-39) for sepsis with organ dysfunction, using an explicit abstraction strategy; and 65% (95%-CI 61-69) using an implicit abstraction strategy. For septic shock, the sensitivity of ICD-10 coding abstraction was 43% (95%-CI 37-50). Agreement of ICD-10 coding abstraction with validated study data varied by the underlying infection type and disease severity (p < 0.05). The estimated national incidence of sepsis, inferred from ICD-10 coding abstraction, was 12.5 per 100,000 children (95%-CI 11.7-13.5) and 21.0 per 100,000 children (95%-CI 19.8-22.2) using validated study data.

Conclusions: In this population-based study, we found a poor representation of sepsis and sepsis with organ dysfunction by ICD-10 coding abstraction in children with blood culture-proven sepsis when compared against a prospective validated research dataset. Sepsis estimates in children based on ICD-10 coding may thus severely underestimate the true prevalence of the disease.

Supplementary information: The online version contains supplementary material available at 10.1007/s44253-023-00006-1.

Keywords: Bacteremia; Clinical coding; Critical care; International Classification of Diseases; Population surveillance; Systemic inflammatory response syndrome.