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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

Characteristic 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)
Timeframe/horizon 28 hours Entire hospital stay
Strengths 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
Limitations 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.