Abstract：
BACKGROUND: Sepsis surveillance using electronic health record (EHR)-based data may provide more accurate epidemiologic estimates than administrative data, but experience with this approach to estimate population-level sepsis burden is lacking.
METHODS: This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews.
RESULTS: Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52-0.55, p < 0.001).
CONCLUSIONS: An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
METHODS: This was a retrospective cohort study including all adults admitted to publicly-funded hospitals in Hong Kong between 2009-2018. Sepsis was defined as clinical evidence of presumed infection (clinical cultures and treatment with antibiotics) and concurrent acute organ dysfunction (≥2 point increase in baseline SOFA score). Trends in incidence, mortality, and case fatality risk (CFR) were modelled by exponential regression. Performance of the EHR-based definition was compared with 4 administrative definitions using 500 medical record reviews.
RESULTS: Among 13,550,168 hospital episodes during the study period, 485,057 (3.6%) had sepsis by EHR-based criteria with 21.5% CFR. In 2018, age- and sex-adjusted standardized sepsis incidence was 759 per 100,000 (relative +2.9%/year [95%CI 2.0, 3.8%] between 2009-2018) and standardized sepsis mortality was 156 per 100,000 (relative +1.9%/year [95%CI 0.9,2.9%]). Despite decreasing CFR (relative -0.5%/year [95%CI -1.0, -0.1%]), sepsis accounted for an increasing proportion of all deaths (relative +3.9%/year [95%CI 2.9, 4.9%]). Medical record reviews demonstrated that the EHR-based definition more accurately identified sepsis than administrative definitions (AUC 0.91 vs 0.52-0.55, p < 0.001).
CONCLUSIONS: An objective EHR-based surveillance definition demonstrated an increase in population-level standardized sepsis incidence and mortality in Hong Kong between 2009-2018 and was much more accurate than administrative definitions. These findings demonstrate the feasibility and advantages of an EHR-based approach for widescale sepsis surveillance.
摘要：
背景：使用基于电子健康记录（EHR）的数据进行的脓毒症监测可能比管理数据提供更准确的流行病学估计，但缺乏这种方法来估计人群级脓毒症负担的经验.
方法：这是一项回顾性队列研究，包括2009年至2018年期间在香港公立医院收治的所有成年人。脓毒症定义为假定感染（临床培养和抗生素治疗）和并发急性器官功能障碍（基线SOFA评分增加≥2分）的临床证据。发病率趋势，死亡率,和病死率风险（CFR）通过指数回归进行建模。使用500份病历审查，将基于EHR的定义的性能与4个管理定义进行了比较。
结果：在研究期间的13,550,168次医院事件中，根据基于EHR的标准，485,057（3.6％）患有脓毒症，CFR为21.5％。2018年，年龄和性别调整后的标准化脓毒症发病率为759/100,000（2009-2018年间相对+2.9%/年[95CI2.0,3.8%]），标准化脓毒症死亡率为156/100,000（相对+1.9%/年[95CI0.9,2.9%]）。尽管CFR下降（相对-0.5%/年[95CI-1.0，-0.1%]），脓毒症占所有死亡的比例越来越高(相对而言+3.9%/年[95CI2.9,4.9%]).医学记录回顾表明，基于EHR的定义比管理定义更准确地识别脓毒症（AUC0.91vs0.52-0.55，p<0.001）。
结论：基于EHR的客观监测定义表明，2009年至2018年期间，香港人群标准化败血症发病率和死亡率有所增加，并且比行政定义更准确。这些发现证明了基于EHR的方法用于大规模脓毒症监测的可行性和优势。
方法：这是一项回顾性队列研究，包括2009年至2018年期间在香港公立医院收治的所有成年人。脓毒症定义为假定感染（临床培养和抗生素治疗）和并发急性器官功能障碍（基线SOFA评分增加≥2分）的临床证据。发病率趋势，死亡率,和病死率风险（CFR）通过指数回归进行建模。使用500份病历审查，将基于EHR的定义的性能与4个管理定义进行了比较。
结果：在研究期间的13,550,168次医院事件中，根据基于EHR的标准，485,057（3.6％）患有脓毒症，CFR为21.5％。2018年，年龄和性别调整后的标准化脓毒症发病率为759/100,000（2009-2018年间相对+2.9%/年[95CI2.0,3.8%]），标准化脓毒症死亡率为156/100,000（相对+1.9%/年[95CI0.9,2.9%]）。尽管CFR下降（相对-0.5%/年[95CI-1.0，-0.1%]），脓毒症占所有死亡的比例越来越高(相对而言+3.9%/年[95CI2.9,4.9%]).医学记录回顾表明，基于EHR的定义比管理定义更准确地识别脓毒症（AUC0.91vs0.52-0.55，p<0.001）。
结论：基于EHR的客观监测定义表明，2009年至2018年期间，香港人群标准化败血症发病率和死亡率有所增加，并且比行政定义更准确。这些发现证明了基于EHR的方法用于大规模脓毒症监测的可行性和优势。
