Evaluating Potential Missed Opportunities to Prevent, Treat, or Diagnose Sepsis: A Population-Based Retrospective Study of Insurance Claims.

Abstract

Importance: Delays in diagnosing sepsis may increase morbidity and mortality, but the frequency of delays is poorly understood.

Objectives: The aim of this study was to estimate the frequency and duration of diagnostic delays for sepsis and potential risk factors for delay.

Design, setting, and participants: We conducted a retrospective case-crossover analysis of sepsis cases from 2016 to 2019 using claims from Merative MarketScan. We ascertained the index diagnosis of sepsis and corresponding hospitalization. We analyzed healthcare visits in the 180 days before diagnosis and then compared the observed and expected trends in signs or symptoms of infection, immune or organ dysfunction (e.g., fever, dyspnea) during the 14 days before diagnosis. A bootstrapping approach was used to estimate the frequency and duration of potential diagnostic delays along with possible risk-factors for experiencing a delay.

Main outcomes and measures: The number of patients who experienced a potential diagnostic delay, duration of delay, and number of potential missed opportunities.

Results: We identified a total of 649,756 cases of sepsis from 2016 to 2019 meeting inclusion criteria. There was an increase in visits with signs or symptoms of infection, immune or organ dysfunction just before the index diagnosis of sepsis. We estimated that around 16.57% (95% CI, 16.38-16.78) of patients experienced a potential diagnostic delay, with a mean delay duration of 3.21 days (95% CI, 3.13-3.27) and a median of 2 days. Most delays occurred in outpatient settings. Potential diagnostic delays were more frequent among younger age groups and patients who received antibiotics (odds ratio [OR] 2.58 [95% CI, 2.54-2.62]), or treatments for particular symptoms, including opioids (OR 1.43 [95% CI, 1.40-1.46]) and inhalers (OR 1.37 [95% CI, 1.33-1.40]).

Conclusions and relevance: There may be a substantial number of potential missed opportunities to diagnose sepsis, especially in outpatient settings. Multiple factors might contribute to delays in diagnosing sepsis including commonly prescribed medications for symptoms.