Population sepsis incidence, mortality, and trends in Hong Kong between 2009-2018 using clinical and administrative data
© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America..
BACKGROUND: Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking.
METHODS: This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews.
RESULTS: Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52-0.55, p < 0.001).
CONCLUSIONS: An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2023 |
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| Enthalten in: |
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America - (2023) vom: 19. Aug. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Ling, Lowell [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical coding |
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| Anmerkungen: |
Date Revised 19.08.2023 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1093/cid/ciad491 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM360956246 |
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| 041 | |a eng | ||
| 100 | 1 | |a Ling, Lowell |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Population sepsis incidence, mortality, and trends in Hong Kong between 2009-2018 using clinical and administrative data |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Revised 19.08.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America. | ||
| 520 | |a BACKGROUND: Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking | ||
| 520 | |a METHODS: This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews | ||
| 520 | |a RESULTS: Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52-0.55, p < 0.001) | ||
| 520 | |a CONCLUSIONS: An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Sepsis-3 | |
| 650 | 4 | |a clinical coding | |
| 650 | 4 | |a epidemiology | |
| 650 | 4 | |a infections | |
| 650 | 4 | |a multiple organ failure | |
| 650 | 4 | |a surveillance | |
| 650 | 4 | |a urban population | |
| 700 | 1 | |a Zhang, Jack Zhenhe |e verfasserin |4 aut | |
| 700 | 1 | |a Chang, Lok Ching |e verfasserin |4 aut | |
| 700 | 1 | |a Chiu, Lok Ching Sandra |e verfasserin |4 aut | |
| 700 | 1 | |a Ho, Samantha |e verfasserin |4 aut | |
| 700 | 1 | |a Ng, Pauline Yeung |e verfasserin |4 aut | |
| 700 | 1 | |a Dharmangadan, Manimala |e verfasserin |4 aut | |
| 700 | 1 | |a Lau, Chi Ho |e verfasserin |4 aut | |
| 700 | 1 | |a Ling, Steven |e verfasserin |4 aut | |
| 700 | 1 | |a Man, Man Yee |e verfasserin |4 aut | |
| 700 | 1 | |a Fong, Ka Man |e verfasserin |4 aut | |
| 700 | 1 | |a Liong, Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Yeung, Alwin Wai Tak |e verfasserin |4 aut | |
| 700 | 1 | |a Au, Gary Ka Fai |e verfasserin |4 aut | |
| 700 | 1 | |a Chan, Jacky Ka Hing |e verfasserin |4 aut | |
| 700 | 1 | |a Tang, Michele |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, Ying Zhi |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, William Ka Kei |e verfasserin |4 aut | |
| 700 | 1 | |a Wong, Wai Tat |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Peng |e verfasserin |4 aut | |
| 700 | 1 | |a Cowling, Benjamin J |e verfasserin |4 aut | |
| 700 | 1 | |a Lee, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Rhee, Chanu |e verfasserin |4 aut | |
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