David F Gaieski, Jumpei Tsukuda, Parker Maddox, Michael Li
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Comparing sepsis ICD-10 code + COVID-19 diagnosis patients to sepsis ICD-10 code only and COVID-19 diagnosis-only patients, the sepsis ICD-10 code + COVID-19 diagnosis patients were: older (69 [58-78] vs 67 [56-77] vs 64 [51-76] yr), less likely to be female (40.3% vs 46.7% vs 49.5%), more frequently admitted to the ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15% [1,042/6,945]), more frequently required ventilatory support (39.3% [453/1,153] vs 31.8% [1,049/3,297] vs 6.0% [417/6,945]), had longer median hospital length of stay (9 [5,16] vs 5 [3,8] vs 7. [4,13] d), and were more likely to die in the hospital (39.2% [452/1,153] vs 22.3% [735/3,297] vs 6.4% [444/6,945]).</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic the sickest cohort of patients was those receiving an explicit ICD-10 code of sepsis + a COVID-19 diagnosis. A significant percentage of COVID-19 diagnosis-only patients appear to have been under-coded as they received a level of critical care (ICU admission; intubation) suggestive of the presence of acute organ dysfunction during their admission.</p>","PeriodicalId":10759,"journal":{"name":"Critical Care Explorations","volume":"5 9","pages":"e0964"},"PeriodicalIF":0.0000,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/73/8a/cc9-5-e0964.PMC10461943.pdf","citationCount":"0","resultStr":"{\"title\":\"Are Patients With an International Classification of Diseases, 10th Edition Discharge Diagnosis Code for Sepsis Different in Regard to Demographics and Outcome Variables When Comparing Those With Sepsis Only to Those Also Diagnosed With COVID-19 or Those With a COVID-19 Diagnosis Alone?\",\"authors\":\"David F Gaieski, Jumpei Tsukuda, Parker Maddox, Michael Li\",\"doi\":\"10.1097/CCE.0000000000000964\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>We analyzed whether patients with the International Classification of Diseases, 10th Edition (ICD-10) discharge diagnosis code for sepsis are different in regard to demographics and outcome variables when comparing those with sepsis only to those also diagnosed with COVID-19 or those with a COVID-19 diagnosis alone.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Nine hospitals in an academic health system.</p><p><strong>Patients: </strong>Patients with a final ICD-10 discharge diagnostic code for sepsis only, a diagnosis of COVID-19-only, or a final sepsis ICD-10 discharge code + a diagnosis of COVID-19 admitted to the hospital were analyzed for demographic and outcome differences between the cohorts.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>A total of 11,395 patients met inclusion criteria: 6,945 patients (60.9%) were ICD-10 sepsis code only, 3,294 patients (28.9%) were COVID-19 diagnosis-only, and 1,153 patients (10.1%) were sepsis ICD-10 code + COVID-19 diagnosis. Comparing sepsis ICD-10 code + COVID-19 diagnosis patients to sepsis ICD-10 code only and COVID-19 diagnosis-only patients, the sepsis ICD-10 code + COVID-19 diagnosis patients were: older (69 [58-78] vs 67 [56-77] vs 64 [51-76] yr), less likely to be female (40.3% vs 46.7% vs 49.5%), more frequently admitted to the ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15% [1,042/6,945]), more frequently required ventilatory support (39.3% [453/1,153] vs 31.8% [1,049/3,297] vs 6.0% [417/6,945]), had longer median hospital length of stay (9 [5,16] vs 5 [3,8] vs 7. [4,13] d), and were more likely to die in the hospital (39.2% [452/1,153] vs 22.3% [735/3,297] vs 6.4% [444/6,945]).</p><p><strong>Conclusions: </strong>During the COVID-19 pandemic the sickest cohort of patients was those receiving an explicit ICD-10 code of sepsis + a COVID-19 diagnosis. 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引用次数: 0
摘要
目的:我们分析使用国际疾病分类第10版(ICD-10)脓毒症出院诊断代码的患者与仅诊断为COVID-19的患者或仅诊断为COVID-19的患者相比，在人口统计学和结局变量方面是否存在差异。设计:回顾性队列研究。环境:一个学术卫生系统中的九家医院。患者:分析最终ICD-10出院诊断代码仅为败血症、仅诊断为COVID-19或最终败血症ICD-10出院代码+诊断为COVID-19入院的患者的人口统计学和结局差异。干预措施:没有。测量结果及主要结果:共11395例患者符合纳入标准:仅ICD-10败血症代码6945例(60.9%)，仅诊断COVID-19的3294例(28.9%)，败血症ICD-10代码+ COVID-19诊断的1153例(10.1%)。将败血症ICD-10编码+ COVID-19诊断患者与仅ICD-10编码和仅诊断COVID-19的患者进行比较，败血症ICD-10编码+ COVID-19诊断患者为:年龄较大(69岁[58-78岁]vs 67岁[56-77岁]vs 64岁[51-76岁])，女性较少(40.3% vs 46.7% vs 49.5%)，更频繁地入住ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15%[1,042/6,945])，更频繁地需要呼吸支持(39.3% [453/1,153]vs 31.8% [1,049/3,297] vs 6.0%[417/6,945])，住院时间中位数更长(9 [5,16]vs 5 [3,8] vs 7)。[4,13] d)，并且更容易在医院死亡(39.2% [452/1,153]vs 22.3% [735/3,297] vs 6.4%[444/6,945])。结论:在COVID-19大流行期间，病情最严重的患者队列是接受明确的ICD-10败血症代码+ COVID-19诊断的患者。很大一部分仅诊断为COVID-19的患者似乎被低估了，因为他们接受了一定程度的重症监护(ICU入院;插管)提示入院时存在急性器官功能障碍。
Are Patients With an International Classification of Diseases, 10th Edition Discharge Diagnosis Code for Sepsis Different in Regard to Demographics and Outcome Variables When Comparing Those With Sepsis Only to Those Also Diagnosed With COVID-19 or Those With a COVID-19 Diagnosis Alone?
Objectives: We analyzed whether patients with the International Classification of Diseases, 10th Edition (ICD-10) discharge diagnosis code for sepsis are different in regard to demographics and outcome variables when comparing those with sepsis only to those also diagnosed with COVID-19 or those with a COVID-19 diagnosis alone.
Design: Retrospective cohort study.
Setting: Nine hospitals in an academic health system.
Patients: Patients with a final ICD-10 discharge diagnostic code for sepsis only, a diagnosis of COVID-19-only, or a final sepsis ICD-10 discharge code + a diagnosis of COVID-19 admitted to the hospital were analyzed for demographic and outcome differences between the cohorts.
Interventions: None.
Measurements and main results: A total of 11,395 patients met inclusion criteria: 6,945 patients (60.9%) were ICD-10 sepsis code only, 3,294 patients (28.9%) were COVID-19 diagnosis-only, and 1,153 patients (10.1%) were sepsis ICD-10 code + COVID-19 diagnosis. Comparing sepsis ICD-10 code + COVID-19 diagnosis patients to sepsis ICD-10 code only and COVID-19 diagnosis-only patients, the sepsis ICD-10 code + COVID-19 diagnosis patients were: older (69 [58-78] vs 67 [56-77] vs 64 [51-76] yr), less likely to be female (40.3% vs 46.7% vs 49.5%), more frequently admitted to the ICU (59.3% [684/1,153] vs 54.9% [1,810/3,297] vs 15% [1,042/6,945]), more frequently required ventilatory support (39.3% [453/1,153] vs 31.8% [1,049/3,297] vs 6.0% [417/6,945]), had longer median hospital length of stay (9 [5,16] vs 5 [3,8] vs 7. [4,13] d), and were more likely to die in the hospital (39.2% [452/1,153] vs 22.3% [735/3,297] vs 6.4% [444/6,945]).
Conclusions: During the COVID-19 pandemic the sickest cohort of patients was those receiving an explicit ICD-10 code of sepsis + a COVID-19 diagnosis. A significant percentage of COVID-19 diagnosis-only patients appear to have been under-coded as they received a level of critical care (ICU admission; intubation) suggestive of the presence of acute organ dysfunction during their admission.
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