Chest
Original ResearchCritical CareNationwide Trends of Severe Sepsis in the 21st Century (2000–2007)
Section snippets
Data Source
NIS is the largest all-payer inpatient-care database publicly available in the United States. It is an administrative data set created by the Agency for Healthcare Research and Quality from data contributed by participating states. During the study years, it contained data on 5 to 8 million hospital stays from about 1,000 hospitals sampled to approximate a 20% sample of US community hospitals, defined by the American Hospital Association to be “all non-Federal, short-term, general, and other
Results
The annual number of discharges with severe sepsis increased from 300,270 (0.99% of all hospitalizations) in 2000 to 781,725 (2.38% of all hospitalizations) in 2007, amounting to a 160% increase over the span of the study period (e-Fig 1, Fig 1). The frequency of hospitalizations with severe sepsis increased from 143 per 100,000 US adults in 2000 to 343 per 100,000 in 2007, an average annual increase of 16.5%. As shown in Figure 2, the increase was quite consistent throughout this period and
Discussion
We have demonstrated that the increases in the frequency of severe sepsis through 2000 documented by others have continued, and even accelerated, during the period from 2000 to 2007 (e-Table 6). Moreover, despite remarkable improvements in severity-adjusted mortality during this time frame, the marked increase in hospitalizations has led to a continued striking increase in the number of deaths associated with severe sepsis. Similar trends were observed for septic shock, where the incidence
Conclusions
Despite its limitations, our study provides an important extension of prior work and suggests future directions for research and policy. It reiterates prior warnings that severe sepsis is an increasingly important contributor to hospitalizations, hospital deaths, and, importantly, discharges to SNF. Policy-makers and health-care systems must be ready to meet the needs of this population. Specifically, there is a need to identify approaches that can help the growing cohort of persons discharged
Acknowledgments
Author contributions: Dr Nanchal had full access to the data and vouches for its integrity.
Dr G. Kumar: contributed to the study design, statistical analysis, and writing of the manuscript.
Dr N. Kumar: contributed to the critical review and revision of the manuscript.
Dr Taneja: contributed to the critical review and revision of the manuscript.
Dr Kaleekal: contributed to the critical review and revision of the manuscript.
Dr Tarima: contributed to the statistical analysis and revision of the
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Funding/Support: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).