Defining Posttraumatic Sepsis for Population-Level Research
Authors' conclusion
In this cohort study of critically ill patients with trauma, administrative methods misclassified sepsis and underestimated the incidence and severity of sepsis compared with an automated clinical method using data from the electronic health record.
Study context
- Population
- Patients aged ≥16 years with traumatic injury admitted to the ICU and requiring invasive mechanical ventilation for ≥3 days, 2012–2020
- Participants
- 3,194 patients
- Exposure
- Automated clinical criteria vs National Trauma Data Bank (NTDB) vs Medical billing codes
- Automated clinical criterian = 747
- NTDBn = 118
- Medical billing codesn = 529
- Outcome
- Chronic critical illness and in-hospital mortality
Methodological detailssingle-institution level 1 trauma center
- Single-institution level 1 trauma center
Main finding
As reported in the abstract
Estimate (95% CI)
Automated clinical criteria
adjusted RR of chronic critical illness 9.9(8.0–12.3)
NTDB
adjusted RR of chronic critical illness 5.0(3.4–7.3)
Medical billing codes
adjusted RR of chronic critical illness 4.5(3.6–5.6)
Automated clinical criteria
adjusted RR of in-hospital mortality 1.3(1.0–1.6)
NTDB
adjusted RR of in-hospital mortality 2.7(1.7–4.3)
Medical billing codes
adjusted RR of in-hospital mortality 1.0(0.7–1.2)
Observational data: associations, not effects.
Secondary outcomes
Sepsis incidence by classification method
3-way agreement between methods
- Light κ
- 0.16 (95% CI, 0.14-0.19)
Original publication
Defining Posttraumatic Sepsis for Population-Level Research. JAMA Netw Open. Published 3 January 2023. doi:10.
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