BACKGROUND Claims-based algorithms are commonly used to identify sepsis in health services research because the laboratory features required to define clinical criteria may not be available in administrative data. METHODS We evaluated claims-based sepsis algorithms among adults in the US aged ≥65 years with Medicare health insurance enrolled in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Suspected infections from baseline (2003-2007) through December 31, 2012 were analyzed. Two claims-based algorithms were evaluated: (1) infection plus organ dysfunction diagnoses or sepsis diagnoses (Medicare-Implicit/Explicit) and (2) Centers for Medicare and Medicaid Services Severe Sepsis/Septic Shock Measure diagnoses (Medicare-CMS). Three classifications based on clinical criteria were used as standards for comparison: (1) the sepsis-related organ failure assessment (SOFA) score (REGARDS-SOFA), (2) "quick" SOFA (REGARDS-qSOFA), and (3) Centers for Disease Control and Prevention electronic health record criteria (REGARDS-EHR). RESULTS There were 2217 suspected infections among 9522 participants included in the current study. The total number of suspected infections classified as sepsis was 468 for Medicare-Implicit/Explicit, 249 for Medicare-CMS, 541 for REGARDS-SOFA, 185 for REGARDS-qSOFA, and 331 for REGARDS-EHR. The overall agreement between Medicare-Implicit/Explicit and REGARDS-SOFA, REGARDS-qSOFA, and REGARDS-EHR was 77, 79, and 81%, respectively, sensitivity was 46, 53, and 57%, and specificity was 87, 82, and 85%. Comparing Medicare-CMS and REGARDS-SOFA, REGARDS-qSOFA, and REGARDS-EHR, agreement was 77, 87, and 85%, respectively, sensitivity was 27, 41, and 36%, and specificity was 94, 92, and 93%. Events meeting the REGARDS-SOFA classification had a lower 90-day mortality rate (140.7 per 100 person-years) compared with the Medicare-CMS (296.1 per 100 person-years), REGARDS-qSOFA (238.6 per 100 person-years), Medicare-Implicit/Explicit (219.4 per 100 person-years), and REGARDS-EHR classifications (201.8 per 100 person-years). CONCLUSION Claims-based sepsis algorithms have high agreement and specificity but low sensitivity when compared with clinical criteria. Both claims-based algorithms identified a patient population with similar 90-day mortality rates as compared with classifications based on qSOFA and EHR criteria but higher mortality relative to SOFA criteria.

中文翻译：

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中风地理和种族差异原因 (REGARDS) 队列中用于识别脓毒症的基于索赔的方法与临床标准的一致。


背景技术基于声明的算法通常用于在卫生服务研究中识别脓毒症，因为定义临床标准所需的实验室特征可能无法在管理数据中获得。方法 我们对参与脑卒中地理和种族差异原因 (REGARDS) 研究的 Medicare 健康保险的美国 65 岁以上成年人评估了基于索赔的脓毒症算法。对从基线（2003-2007 年）到 2012 年 12 月 31 日期间的疑似感染情况进行了分析。评估了两种基于索赔的算法：(1) 感染加器官功能障碍诊断或败血症诊断（Medicare-隐式/显式）和 (2) 医疗保险和医疗补助服务中心严重败血症/败血性休克测量诊断 (Medicare-CMS)。基于临床标准的三种分类用作比较标准：（1）脓毒症相关器官衰竭评估（SOFA）评分（REGARDS-SOFA），（2）“快速”SOFA（REGARDS-qSOFA），以及（3）疾病控制和预防中心电子健康记录标准 (REGARDS-EHR)。结果 本研究纳入的 9522 名参与者中有 2217 名疑似感染者。被归类为脓毒症的疑似感染总数为 Medicare-Implicit/Explicit 为 468 例，Medicare-CMS 为 249 例，REGARDS-SOFA 为 541 例，REGARDS-qSOFA 为 185 例，REGARDS-EHR 为 331 例。 Medicare-Implicit/Explicit 与 REGARDS-SOFA、REGARDS-qSOFA 和 REGARDS-EHR 之间的总体一致性分别为 77%、79% 和 81%，敏感性分别为 46%、53% 和 57%，特异性为 87%、82%。和85%。比较 Medicare-CMS 与 REGARDS-SOFA、REGARDS-qSOFA 和 REGARDS-EHR，一致性分别为 77%、87% 和 85%，敏感性为 27%、41% 和 36%，特异性为 94%、92% 和 93% 。 与 Medicare-CMS（每 100 人年 296.1 人）、REGARDS-qSOFA（每 100 人年 238.6 人）相比，符合 REGARDS-SOFA 分类的事件的 90 天死亡率较低（每 100 人年 140.7 人）， Medicare-隐性/显性（每 100 人年 219.4）和 REGARDS-EHR 分类（每 100 人年 201.8）。结论 与临床标准相比，基于索赔的脓毒症算法具有较高的一致性和特异性，但敏感性较低。两种基于索赔的算法都确定了与基于 qSOFA 和 EHR 标准的分类相比具有相似 90 天死亡率的患者群体，但相对于 SOFA 标准的死亡率更高。