Validity of administrative data in recording sepsis: a systematic review

Rachel J Jolley, Keri Jo Sawka, Dean W Yergens, Hude Quan, Nathalie Jetté, Christopher J Doig

Administrative health data have been used to study sepsis in large population-based studies. Validity of these study findings depends largely on the quality of the administrative data source and the validity of the case definition used. We systematically reviewed the literature to assess the validity of case definitions of sepsis used with administrative data. Embase and MEDLINE were searched for published articles with International Classification of Diseases (ICD) coded data used to define sepsis. Abstracts and full text articles were reviewed in duplicate. Data were abstracted from all eligible full text articles, including ICD-9 and/or ICD-10 based case definitions, sensitivity (Sn), specificity (Sp), positive predictive values (PPV) and negative predictive values (NPV). Of 2317 individual studies identified, 12 full text articles met all eligibility criteria. A total of 38 sepsis case definitions were tested, which included over 130 different ICD codes. The most common ICD-9 codes were 038.x, 790.7, and 995.92 and ICD-10 codes were A40.x and A41.x. The PPV was reported in 10 studies, and ranged from 5.6% to 100% with a median of 50%. Other tests of diagnostic accuracy were only reported in some studies. Sn ranged from 5.9% to 82.3%, Sp ranged from 78.3% to 100% and NPV ranged from 62.1% to 99.7%. Validity of administrative data in recording sepsis varied substantially across individual studies and ICD definitions. Our work may serve as a reference point for consensus towards an improved harmonized ICD-coded definition of sepsis.