Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about...

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Sepsis Kills You Can Count On It Paul Huggan

Transcript of Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about...

Page 1: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Sepsis Kills – You

Can Count On It

Paul Huggan

Page 2: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

This is a talk about sepsis epidemiology….

• Are 1% of the adult population in New Zealand

admitted to hospital with sepsis each year?

Page 3: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Data doesn’t define people

Page 4: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Background

Page 5: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

INFECTION

ORGAN

FAILUREICU

SEPSIS

Page 6: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

“Our study provides evidence that

sepsis-related mortality has

steadily decreased over time even

after adjustments for illness

severity, center effect, regional

effects, hospital size, risk

of being septic, and other key

variables.”

Page 7: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted
Page 8: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Clinical vs ANZICS CORE Definition

Clinical ANZICS CORE P- value

ICU Prevalence 16.9% 11% <0.001

Septic shock 5.7% 9.6% <0.001

In-hospital death 27% 17% 0.12

In-hospital death

(shock)

37% 16% 0.006

“Database criteria significantly underestimate incidence of sepsis and

overestimate incidence of septic shock, resulting in lower estimated hospital

mortality rates for each condition”

Page 9: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

INFECTION

In

Hospital

Page 10: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Infectious disease hospitalisation in New Zealand

▪ Infections are the most common cause of

hospitalisation in NZ

▪ Twice the rate of admission amongst Maaori and

Pacific people compared with European/other

▪ Almost 3 times rate of admission amongst most

deprived (NZDep 9-10) compared with the least

Page 11: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

INFECTION

ORGAN

FAILUREHospital

SEPSIS

Page 12: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

A: Infection (n=48) B: Organ Failure (n=69)

+

Defining Sepsis using ICD-10-AM

Page 13: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Waikato DHB Sepsis

Per 100,000 population

• Total

• 500

• Over 65

• 2500

• Admitted to ICU

• 17%

• Mortality

• 18% in hospital

• 37% at one year

Page 14: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted
Page 15: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

“Isn’t coding rubbish?”

• New codes and coding strategies (Gohil et al)

– Introduction of dedicated “sepsis” code (2002)

– Introduction of DRG system (2007)

• Laboratory paradox

– Increasing incidence of ICD9 sepsis, falling

bacteremia and lactatemia rates (Rhee et al)

Page 16: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Objective evaluation vs medical records

Sn - ≥ 5.6%

Sp - ≥ 78%

Sn* - ≥ 42.6%

Sp* - ≥ 86%

* Angus et al Crit Care Med 2001

Page 17: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Novel methods to estimate incidence

Page 18: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Other insights

Page 19: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted
Page 20: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Sepsis Admissions, Waikato DHB

With thanks to Sheena Moosa

Page 21: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Impact of QI initiative – “Sepsis Ready”

Page 22: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Thank you

Page 23: Sepsis Kills You Can Count On ItSepsis Kills –You Can Count On It Paul Huggan This is a talk about sepsis epidemiology…. • Are 1% of the adult population in New Zealand admitted

Sepsis: A National Approach

Sepsis.org.nz