Evaluation and Comparison of Sepsis Definitions (PIs: Chanu Rhee, MD, MPH; Michael Klompas, MD, MPH
The aims of this multicenter project (conducted in collaboration with University of Washington in St. Louis and Duke University) were to: 1) Evaluate and compare the clinical characteristics, associated morbidity and mortality, and overlap of the Sepsis-3 clinical definition with the proposed Epicenters’ EHR-based sepsis surveillance definition and sepsis administrative claims definitions, 2) Determine the attributable mortality of hospital-onset sepsis and identify the associated clinical characteristics and comorbidities of patients who die from sepsis, and 3) Quantify interobserver variability in assessing compliance with the CMS sepsis measure.
Sepsis Time Zero
A major barrier to providing appropriate sepsis care is our limited understanding of which specific clinical presentations are most likely to benefit from immediate antibiotics and fluids and which can safely be managed more conservatively. Additionally, we have an imperfect understanding of which care processes are critical to optimizing patient outcomes. To address these gaps, we are researching better ways to define sepsis “time zero,” a concept that embodies both the criteria that should trigger immediate interventions when infection is suspected and the point from which timeliness of care is measured. In this project, we are leveraging detailed EHR data from millions of encounters across 167 hospitals in two datasets in support of the following aims: 1) Develop evidence-based, objective, and electronically computable definitions of sepsis time zero by using electronic health record data to identify the clinical signs that are associated with higher mortality when antibiotics are delayed, 2) Systematically evaluate the associations between each sepsis bundle component and mortality and compare the full bundle to simpler, streamlined versions, and 3) Assess whether and how optimal treatment strategies differ for commonly encountered and easily recognizable sepsis phenotypes based on infection site, comorbidities, and clinical signs.
Publications and/or Presentations
Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, Kadri SS, Angus DC, Danner RL, Fiore AE, Jernigan JA, Martin GS, Septimus E, Warren DK, Karcz A, Chan C, Menchaca JT, Wang R, Gruber S, Klompas M.; CDC Prevention Epicenter Program. Incidence and trends of sepsis in US hospitals using clinical vs claims data, 2009-2014. JAMA 318(13):1241-1249. doi: 10.1001/jama.2017.13836 October 3, 2017.
Rhee C, Brown SR, Jones TM, O'Brien C, Pande A, Hamad Y, Bulger AL, Tobin KA, Massaro AF, Anderson DJ, Warren DK, Klompas M; CDC Prevention Epicenters Program. Variability in determining sepsis time zero and bundle compliance rates for the centers for medicare and medicaid services SEP-1 measure. Infect Control Hosp Epidemiol. 2018 Aug;39(8):994-996. doi: 10.1017/ice.2018.134. Epub 2018 Jun 22. PMID: 29932042; PMCID: PMC7977505.
Rhee C, Filbin MR, Massaro AF, Bulger AL, McEachern D, Tobin KA, Kitch BT, Thurlo-Walsh B, Kadar A, Koffman A, Pande A, Hamad Y, Warren DK, Jones TM, O'Brien C, Anderson DJ, Wang R, Klompas M; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program. Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study. Crit Care Med. 2018 Oct;46(10):1585-1591. doi: 10.1097/CCM.0000000000003261. PMID: 30015667; PMCID: PMC6138564.
Rhee C, Jones TM, Hamad Y, Pande A, Varon J, O'Brien C, Anderson DJ, Warren DK, Dantes RB, Epstein L, Klompas M; Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program. Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. JAMA Netw Open. 2019 Feb 1;2(2):e187571. doi: 10.1001/jamanetworkopen.2018.7571. PMID: 30768188; PMCID: PMC6484603.
Rhee C, Zhang Z, Kadri SS, Murphy DJ, Martin GS, Overton E, Seymour CW, Angus DC, Dantes R, Epstein L, Fram D, Schaaf R, Wang R, Klompas M; CDC Prevention Epicenters Program. Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria Versus Sepsis-3 Sequential Organ Failure Assessment Criteria. Crit Care Med. 2019 Mar;47(3):307-314. doi: 10.1097/CCM.0000000000003521. PMID: 30768498; PMCID: PMC6383796.
Rhee C, Jentzsch MS, Kadri SS, Seymour CW, Angus DC, Murphy DJ, Martin GS, Dantes RB, Epstein L, Fiore AE, Jernigan JA, Danner RL, Warren DK, Septimus EJ, Hickok J, Poland RE, Jin R, Fram D, Schaaf R, Wang R, Klompas M. Centers for Disease Control and Prevention (CDC) Prevention Epicenters Program. Variation in identifying sepsis and organ dysfunction using administrative versus electronic clinical data and impact on hospital outcome comparisons. Crit Care Med 47(4):493-500. doi: 10.1097/CCM.0000000000003554 April 2019.
Rhee C, Wang R, Zhang Z, Fram D, Kadri SS, Klompas M; CDC Prevention Epicenters Program. Epidemiology of Hospital-Onset Versus Community-Onset Sepsis in U.S. Hospitals and Association With Mortality: A Retrospective Analysis Using Electronic Clinical Data. Crit Care Med. 2019 Sep;47(9):1169-1176. doi: 10.1097/CCM.0000000000003817. PMID: 31135503; PMCID: PMC6697188.
Rhee C, Wang R, Song Y, Zhang Z, Kadri SS, Septimus EJ, Fram D, Jin R, Poland RE, Hickok J, Sands K, Klompas M. Risk Adjustment for sepsis mortality to facilitate hospital comparisons using Centers for Disease Control and Prevention’s adult sepsis event criteria and routine electronic clinical data. Crit Care Explor 1(10):e0049. doi: 10.1097/CCE.0000000000000049 October 2019.
Rhee C, Li Z, Wang R, Song Y, Kadri SS, Septimus EJ, Chen HC, Fram D, Jin R, Poland R, Sands K, Klompas M. Impact of risk adjustment using clinical vs administrative data on hospital sepsis mortality comparisons. Open Forum Infect Dis 7(6):ofaa213 doi: 10.1093/ofid/ofaa213 Published online June 25, 2020.
Alrawashdeh M, Klompas M, Kimmel S, Larochelle MR, Gokhale RH, Dantes RB, Hoots B, Hatfield KM, Reddy SC, Fiore AE, Septimus EJ, Kadri SS, Poland R, Sands K, Rhee C. Epidemiology, outcomes, and trends of patients with sepsis and opioid-related hospitalizations in U.S. hospitals. Crit Care Med 49(12):2102-2111. doi: 10.1097/CCM.0000000000005141 December 1, 2021. Alrawashdeh M, Klompas M, Simpson SS, Kadri SS, Poland R, Guy JS, Perlin JB, Rhee C; CDC Prevention Epicenters Program. Prevalence and outcomes of previously healthy adults among patients hospitalized with community-onset sepsis. Chest. 2022 Jul;162(1):101-110. doi: 10.1016/j.chest.2022.01.016. Epub 2022 Jan 20.
Funders: Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality