Seven-Day Sepsis Hospitalization Rates Across Healthcare Settings

When sepsis occurs in the hospital, identifying and treating it as quickly as possible are crucial, but there are limited data on sepsis intervention before hospitalization. A study published online as part of the ATS 2020 International Conference assessed the seven-day incidence of suspected infection (SI) or sepsis (S3) in diverse healthcare encounters.

The study took place between 2012 and 2017 in a Northern California regional health system encompassing 4.4 million members. Three risk strata were established: (1) hospital discharge, (2) emergency department (ED) discharge, and (3) ambulatory clinic visits. Enriched scenarios were also identified for each strata; these included ED visits with antibiotics administered, hospital discharges with high readmission risk, and ambulatory visits with infection diagnoses. The seven-day incidence of SI and S3 hospitalization was calculated for each strata and scenario; the number-needed-to-evaluate (NNE) was then calculated for a predictive model to demonstrate a hypothetical 40% sensitivity and 90% specificity.

Final analysis included 1.1 million hospital discharges, 5.8 million ED discharges, and 108.7 million ambulatory visits. The seven-day incidence rates of SI were: hospital discharge, 2.4%; ED discharge, 0.9%; and ambulatory visit, 0.3%. The seven-day incidence rates of S3 were: hospital discharge, 1.4%; ED discharge, 0.4%; and ambulatory visit, 0.1%. Among hospital discharges, sepsis comprised 63.2% of seven-day SI hospitalizations; among ED discharges and ambulatory visits, the rates were 55.5% and 38.1%, respectively. Analyses of the scenarios yielded varied outcomes. When examining hospital discharges with high readmission risk—which constituted 5.8% of all discharges—6.5% had seven-day SI hospitalizations, and 5.1% had seven-day S3 hospitalizations.

ED discharges with high comorbid disease burden comprised 6.3% of all ED discharges; 4.6% had seven-day SI hospitalizations, and 3.1% had seven-day S2 hospitalizations. Ambulatory visits with filled antibiotic prescriptions constituted 8.4% of all visits; seven-day SI and S3 incidences were 0.5% and 0.2%, respectively. The hypothetical NNE to identify a true positive seven-day hospitalization for SI varied, from 5:1 for high readmission risk at hospital discharge to 102:1 for any ambulatory visit. Low NNEs included hospital discharges to subacute nursing facilities (7:1), ED discharges with sequential sepsis-related organ failure assessment ≥2 (7:1), and ambulatory visits with filled antibiotic prescriptions (53:1).

“The rates of incident seven-day hospitalization for SI or S3 vary widely across diverse healthcare strata and scenarios. A systematic approach to assessing baseline rates can be used to select enriched scenarios from which to design optimal pre-sepsis predictive models,” the authors concluded.