The Relationship Between Hospital Capability and Mortality in Sepsis: Development of a Sepsis-Related Hospital Capability Index*
Authors' conclusion
The SRC score has face validity for capability-based groupings of hospitals. Sepsis care may already be de facto regionalized at high-capability hospitals. Low-capability hospitals may have become more adept at treating less complicated sepsis.
Study context
- Population
- Adults (≥ 18 yr) with sepsis directly admitted to nonfederal hospitals in New York (derivation) and Florida and Massachusetts (validation), 201889,069 derivation
- Exposure
- High vs Intermediate vs Low
- Outcome
- Hospital-level sepsis mortality explained (unadjusted R2), SRC score vs sepsis volume
Methodological detailsprincipal component analysis, derivation and validation cohorts, Derivation: 182 New York hospitals; validation: 274 Florida and Massachusetts hospitals
- Principal component analysis
- Derivation and validation cohorts
- Derivation: 182 New York hospitals; validation: 274 Florida and Massachusetts hospitals
Main finding
As reported in the abstract
Derivation cohort: R2 sepsis-related capability (SRC) score vs sepsis volume (p < 0.001 for both)
0.25 vs 0.12
Validation cohort: R2 SRC score vs sepsis volume (p < 0.001 for both)
0.18 vs 0.05
Observational data: associations, not effects.
Further findings
| Outcome | OR (95% CI) | |
|---|---|---|
| Adjusted mortality, high vs low capability | 1.55 (1.25–1.92) | |
| 0.512Odds ratio (log scale) |
Mortality associated with higher hospital capability, ≥3 organ dysfunctions (stratified analysis)
| OR (CI) | ||
|---|---|---|
| Higher hospital capabilityOnly evident among patients with ≥3 organ dysfunctions | 1.88 (1.50–2.34) | |
| 0.512Odds ratio (log scale) |
Correlation with outward transfer rates for sepsis (Spearman r), SRC score vs sepsis volume
- Derivation cohort: SRC score vs sepsis volume
- 0.60 vs 0.50
- Validation cohort: SRC score vs sepsis volume
- 0.51 vs 0.45
Adjusted mortality, high vs low capability
- High-capability hospitals: more acute organ dysfunctions and a higher proportion of surgical hospitalizations than low-capability hospitals
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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