How does HQI Calculate Sepsis Mortality (SEP-3)?

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Description:

In-hospital mortality rate among acute care inpatient discharges meeting the proxy case definition for the Third International Consensus Definition for Sepsis (SEP-3) based on the modified Dombrovskiy Method for case identification.

Under SEP-3, sepsis is defined as life-threatening organ dysfunction due to dysregulated host response to infection, and organ dysfunction is defined as an acute change in total Sequential Organ Failure Assessment (SOFA) score of 2 points or greater secondary to the infection cause. This third sepsis definition, also called Sepsis-3, eliminates the requirement for the presence of  systemic inflammatory response syndrome (SIRS) to define sepsis, and it removed the severe sepsis definition. What was previously called severe sepsis is now the new definition of sepsis.

Note: Although the cases are identified based on meeting the proxy definition for sepsis or septic shock, these conditions are not necessarily the primary diagnoses or causes of death for the cases.

Methodology:

SEP-3 sepsis and septic shock cases are are identified through the presence of combinations of ICD-10-CM diagnosis codes on hospital acute care inpatient discharge records based on a proxy case definition created and maintained by HQI.

Inclusion/Exclusion Criteria:

  1. Include only inpatient discharges
  2. Include only acute care cases (Type of Care equal to 1) 

SEP-3 Sepsis Proxy Case Definition: Cases meeting the inclusion/exclusion criteria above that have one or more primary or secondary diagnosis codes listed in the ICD-10-CM CODES TO IDENTIFY SEPTICEMIA OR SEPSIS code set and one or more primary or secondary diagnosis codes listed in the ICD-10-CM CODES TO IDENTIFY ORGAN DYSFUNCTION code set.

To download the code set used for the proxy case definition, click here.

    Denominator: Total number of acute-care inpatient discharges meeting the proxy case definition during the measurement timeframe.

    Numerator: Number of acute-care inpatient discharges meeting the proxy case definition during the measurement timeframe with a discharge disposition of “Expired” (Disposition of Patient = 20).

    Rate Calculation: Percentage calculated as (Numerator/Denominator) x 100.

    ICD-10-CM CODES TO IDENTIFY SEPTICEMIA OR SEPSIS

    CodeCode Description
    A02.1Salmonella sepsis
    A20.7Septicemic plague
    A21.7Generalized tularemia
    A22.7Anthrax sepsis
    A26.7Erysipelothrix sepsis
    A32.7Listerial sepsis
    A39.1Waterhouse-Friderichsen syndrome
    A39.2Acute meningococcemia
    A39.3Chronic meningococcemia
    A39.4Meningococcemia, unspecified
    A40.xStreptococcal sepsis
    A41.xOther sepsis
    A42.7Actinomycotic sepsis
    A54.86Gonococcal sepsis
    B00.7Disseminated herpesviral disease
    B37.7Candidal sepsis
    I26.01Septic pulmonary embolism with acute cor pulmonale
    I26.90Septic pulmonary embolism without acute cor pulmonale
    I76Septic arterial embolism
    O03.37Sepsis following incomplete spontaneous abortion
    O03.87Sepsis following complete or unsp spontaneous abortion
    O04.87Sepsis following (induced) termination of pregnancy
    O07.37Sepsis following failed attempted termination of pregnancy
    O08.82Sepsis following ectopic and molar pregnancy
    O85Puerperal sepsis
    O86.04Sepsis following an obstetrical procedure
    O86.09Sepsis following an obstetrical procedure other surgical site
    O86.81Puerperal septic thrombophlebitis
    O88.3xObstetric pyemic and septic embolism
    P36.xBacterial sepsis of newborn
    R65.2xSevere Sepsis
    T81.12xxPostprocedural septic shock
    T81.44xxSepsis following a procedure

    ICD-10-CM CODES TO IDENTIFY ORGAN DYSFUNCTION

    Code   Code Description
    A39.1Waterhouse-Friderichsen syndrome
    D65Disseminated intravascular coagulation [defibrination syndrome]
    D69.59Other secondary thrombocytopenia
    D69.6Thrombocytopenia, unspecified
    D69.8Other specified hemorrhagic conditions
    D69.9Hemorrhagic condition, unspecified
    E87.2Acidosis
    E872.0Acidosis, unspecified
    E872.1Acute metabolic acidosis
    E872.2Chronic metabolic acidosis
    E872.9Other acidosis
    E87.4Mixed disorder of acid-base balance
    F05Delirium due to known physiological condition
    F06.0Psychotic disorder with hallucinations due to known physiological condition
    F06.1Catatonic disorder due to known physiological condition
    F06.2Psychotic disorder with delusions due to known physiological condition
    G62.81Critical illness polyneuropathy
    G72.81Critical illness myopathy
    G93.4xOther and unspecified encephalopathy
    G93.6Cerebral edema
    G93.82Brain death
    G93.9Disorder of brain, unspecified
    G96.81Intracranial hypotension
    G96.810Intracranial hypotension, unspecified
    G96.811Intracranial hypotension, spontaneous
    G96.819Other intracranial hypotension
    G96.89Other specified disorders of central nervous system
    I46.8Cardiac arrest due to other underlying condition
    I46.9Cardiac arrest, cause unspecified
    I95.1Orthostatic hypotension
    I95.89Other hypotension
    I95.9Hypotension, unspecified
    J80Acute respiratory distress syndrome
    J96.0xAcute respiratory failure
    J96.2xAcute and chronic respiratory failure
    J96.9xRespiratory failure, unspecified
    J98.01Acute bronchospasm
    J98.9Respiratory disorder, unspecified
    J99Respiratory disorders in diseases classified elsewhere
    K59.81Ogilvie syndrome
    K72.0xAcute and subacute hepatic failure
    K72.9xHepatic failure, unspecified
    K76.2Central hemorrhagic necrosis of liver
    K76.3Infarction of liver
    K76.7Hepatorenal syndrome
    M35.81Multisystem inflammatory syndrome
    N17.xAcute kidney failure
    N19Unspecified kidney failure
    R00.0Tachycardia, unspecified
    R00.1Bradycardia, unspecified
    R03.1Nonspecific low blood-pressure reading
    R06.0Dyspnea
    R06.00Dyspnea unspecified
    R06.03Acute respiratory distress
    R06.09Other forms of dyspnea
    R06.82Tachypnea, not elsewhere classified
    R06.89Other abnormalities of breathing
    R09.02Hypoxemia
    R09.2Respiratory arrest
    R40.0Somnolence
    R40.1Stupor
    R40.20Unspecified coma
    R40.211xComa scale, eyes open, never
    R40.212xComa scale, eyes open, to pain
    R40.213xComa scale, eyes open, to sound
    R40.221xComa scale, best verbal response, none
    R40.222xComa scale, best verbal response, incomprehensible words
    R40.223xComa scale, best verbal response, inappropriate words
    R40.224xComa scale, best verbal response, confused conversation
    R40.231xComa scale, best motor response, none
    R40.232xComa scale, best motor response, extension
    R40.233xComa scale, best motor response, abnormal
    R40.234xComa scale, best motor response, flexion withdrawal
    R40.235xComa scale, best motor response, localizes pain
    R40.242xGlasgow coma scale score 9-12
    R40.243xGlasgow coma scale score 3-8
    R40.244xOther coma, without documented Glasgow coma scale score, or with partial score reported
    R40.2ANontraumatic coma due to underlying condition
    R40.3Persistent vegetative state
    R57.xShock, not elsewhere classified
    R65.2xSevere sepsis
    T81.12xxPostprocedural septic shock