3 Key Factors When Using
Hospital Sepsis Discharge Data

  • Hospital discharge data is easy to obtain but may be misleading due to:
    • Lack of clinical data
    • Subject to documentation limitations
  • Various identification strategies have been developed
  • Conversion from ICD-9 to ICD-10 has expanded sepsis coding options resulting in different incidence rates and patterns.

Chan et al JACEP Open 2022;3:e12782

  • January 1, 2016 – December 31, 2019 review of 3,424,339 discharged hospitalized sepsis cases
  • Vizient database consisting of 50% of the nations acute care providers
    • 97% of academic medical centers
    • 20% of ambulatory providers.
  • 4 sepsis identification strategies based on ICD-10 codes:
    • Martin Method: all sepsis hospitalizations with at least 1 of 21 ICD-10 codes
    • Angus Method: Any 1 of 892 ICD-10 codes for infection PLUS 1 of 47 ICD-10 codes for organ dysfunction
    • CMS SEP-1 designation
    • Explicit Method: ICD-10 codes R65.20 or R65.21
  • Sepsis Subtypes:
    • Community acquired sepsis (CAS)
    • Healthcare associated sepsis (HCAS) – community acquired from inpatient nursing facilities, readmitted within 30 days or history of chronic hemodialysis.
    • Hospital acquired sepsis (HAS) – not flagged as sepsis present on admission

KEY FACTOR #1: 4-fold variability in the incidence of sepsis based on criteria used

  • Lowest incidence of sepsis was with the Explicit criteria (655,853 cases) vs highest incidence with the Angus criteria (1,845,027)
  • A 4-fold increase
  • Nearly half the cases were unique to the Angus criteria
  • Similar cases associated with the remaining 3 criteria


KEY FACTOR #2: Sepsis present on admission remains the major type

  • Incidence per 1000 hospitalizations shown in figure
  • CAS (i.e. sepsis present on admission) remains the predominant finding
  • HCAS is second most prevalent finding and a newly reported finding
  • HAS (sepsis not documented on presentation) is the least prevalent.
    • May be due to a missed diagnosis or sepsis development as a complication after admission

KEY FACTOR #3: HAS has the lowest incidence but poorest outcomes

  • Regardless of the sepsis definition criteria used, HAS consistently has the lowest incidence
  • However, it contributes the greatest negative outcomes
    • Total length of stay (2.1 to 2.8 times higher than CAS)
    • ICU length of stay (2 times higher than CAS)
    • Hospital mortality (2.7 to 3.3 greater mortality risk compared to CAS)


  • Using different criteria to define sepsis upon hospital discharge will dramatically affect incidence rates
  • Sepsis present on admission remains the major source of sepsis patients
  • Sepsis flagged as not present on admission is the lowest occurrence but has the poorest outcomes.
  • Use of multiple criteria may offer a better strategy to identify and characterize sepsis based on discharge data.

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Erkan Hassan is the Co-Founder & Chief Clinical Officer of Sepsis Program Optimization where he designs & oversees the implementation of solutions to optimize sepsis programs.

To discuss your organization’s Barriers of Effective Sepsis Care, contact Erkan by phone (844) 4SEPSIS (844-473-7747), email (erkan@spo.icu), or video chat.