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B96-05 Pain Codes Surge in the Days Before Sepsis Diagnosis
Abstract   Peer reviewed

B96-05 Pain Codes Surge in the Days Before Sepsis Diagnosis

R D Struble, A T Arakkal, A C Miller and P M Polgreen
American journal of respiratory and critical care medicine, Vol.212(Supplement_1), aamag1626190
05/01/2026
DOI: 10.1093/ajrccm/aamag162.6190

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Abstract

Background Early sepsis is often foreshadowed by nonspecific complaints. Pain is common but largely ignored by screening tools. We hypothesized that pain-related diagnoses increase in the weeks preceding sepsis, mirror infection-code trajectories, and could serve as a pragmatic early-warning signal. Methods We used Merative MarketScan® claims to identify adults with a sepsis hospitalization. and retrieved all encounters in the prior 180 days. We defined a prespecified 21-day pre-sepsis diagnosis window. A clinician panel reviewed >24,000 ICD-10 encounter codes and labeled each as pain (signs/symptoms; pain syndromes excluded) or infection. We summarized daily and cumulative frequencies and mapped pain by anatomic location and organ system. To test whether pain “travels with” canonical sepsis features, we generated temporal trends for the 1,000 most frequent ICD-10 codes prior to sepsis and performed k-means clustering across multiple k values. For each k, we defined focal clusters centered on five sepsis-screening anchors, fever (R50), dyspnea (R06.02), tachycardia (R00.0), altered mental status (R41.82), and hypotension (I95.9), and tallied how often each code co-occurred with any anchor. Excess pain-related visits in the final 21 days were estimated relative to trends observed 21-180 days prior. Results (preliminary) 20.02% of patients had pain-related symptoms documented during outpatient or inpatient encounters in the 1-21 days before sepsis diagnosis. Pain frequencies rose steadily as sepsis diagnosis approached and closely paralleled frequencies of infection codes. Abdominal, chest, and back pain predominated; organ-system mapping highlighted gastrointestinal, cardiothoracic, and musculoskeletal signals. In clustering analyses, a substantial subset of common pain codes repeatedly co-clustered with the five sepsis anchors across many values of k, indicating shared temporal occurrences with fever, dyspnea, tachycardia, altered mentation, and hypotension. Compared with the 21-180-day baseline, the final 21 days showed a marked excess of pain-related visits. Conclusions Pain-related diagnoses are frequent, escalate in the weeks before sepsis, and align temporally with infection-related and sepsis-screening features. Location-specific and organ-system categorization, particularly abdominal and chest pain, and clustering with established screening anchors, supports pain as a practical early-warning signal. Incorporating structured pain signals into pre-sepsis surveillance could improve recognition and create actionable opportunities for earlier evaluation and intervention. Further work will validate these findings across health systems and test whether targeted prompts for high-risk pain presentations reduce time to sepsis diagnosis and treatment. This abstract is funded by: NIH CTSA program grant UM1TR004403. CDC Epicenter Grant: Centers for Disease Control and Prevention contract number U54CK000613-05-00
 Pain Cardiac arrhythmia Codes Dyspnea Hypotension Infections Sepsis Trends

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