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Table 7 Comparison of manual medical record review for identification of criterion-standard community-acquired sepsis and severe sepsis, and of Martin and colleagues’ and Angus and colleagues’ discharge diagnoses for sepsis identification [1 , 3 ]

From: Discharge diagnoses versus medical record review in the identification of community-acquired sepsis


Manual medical record review for identification of community-acquired sepsis and severe sepsis

Martin and colleagues’ and Angus and colleagues’ discharge diagnoses for identification of sepsis and severe sepsis

Data source

Manual review of initial hospital records (emergency department and admission notes and laboratory test results from the first 28 hours of hospitalization)

Hospital discharge diagnosis codes

Criteria for sepsis or severe sepsis

Sepsis [infection + ≥2 SIRS criteria]

Sepsis: ICD-9 discharge diagnoses for sepsis (Martin and colleagues; Additional file 1)


Severe sepsis [sepsis + ≥1 SOFA organ dysfunction]

Severe sepsis: ICD-9 discharge diagnoses for [infection + organ dysfunction] (Angus and colleagues; Additional file 2)


28 hours

Entire hospital stay


Based upon structured review of medical records

Can utilize existing hospital discharge data

Focused on initial hospitalization (community-acquired sepsis)

Verified connection between infection and sepsis (infection must be major reason for hospitalization)

Extensive data on pre-existing comorbid conditions


Limited to the REGARDS cohort

Limited information on pre-existing comorbid conditions

Requires manual review of medical records

Cannot differentiate initial (community-acquired) from later (hospital-acquired) sepsis

Limited to initial hospitalization presentation and records – cannot detect later (hospital-acquired) sepsis

Depends upon accuracy of coded discharge diagnoses

Assumes connection between coded infection and organ dysfunction (Angus and colleagues)

  1. ICD-9, International Classifications of Diseases, 9th edition; REGARDS, Reasons for Geographic and Racial Differences in Stroke; SIRS, systemic inflammatory response syndrome; SOFA, Sequential Organ Failure Assessment.