Emergency department charges may be associated with mortality in patients with severe sepsis and septic shock: a cohort study

Nicholas M Mohr; Ryan Dick-Perez; Azeemuddin Ahmed; Karisa K. Harland; Dan Shane; Daniel Miller; Christine Miyake; Levi Kannedy; Brian M. Fuller; James C. Torner

doi:10.1186/s12873-018-0212-3

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Emergency department charges may be associated with mortality in patients with severe sepsis and septic shock: a cohort study

Journal article

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Emergency department charges may be associated with mortality in patients with severe sepsis and septic shock: a cohort study

Nicholas M Mohr, Ryan Dick-Perez, Azeemuddin Ahmed, Karisa K. Harland, Dan Shane, Daniel Miller, Christine Miyake, Levi Kannedy, Brian M. Fuller and James C. Torner

BMC Emergency Medicine, Vol.18(1), 62

12/29/2018

DOI: 10.1186/s12873-018-0212-3

PMCID: PMC6310923

PMID: 30594140

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Published (Version of record)Mohret al. BMC Emergency Medicine (2018) 18:62

Abstract

Background Sepsis severity of illness is challenging to measure using claims, which makes sepsis difficult to study using administrative data. We hypothesized that emergency department (ED) charges may be associated with hospital mortality, and could be a surrogate marker of severity of illness for research purposes. The objective of this study was to measure concordance between ED charges and mortality in admitted patients with severe sepsis or septic shock. Methods Cohort study of all adult patients presenting to a 60,000-visit Midwestern academic ED with severe sepsis or septic shock (by ICD-9 codes) between July 1, 2008 and June 30, 2010. Data on demographics, admission APACHE-II score, and disposition was extracted from the medical record, and comorbidities were identified from diagnosis codes using the Elixhauser methodology. Summary statistics were reported and bivariate concordance was tested using Pearson correlation. Logistic regression models for 28-day mortality were developed to measure the independent association with mortality. Results We included a total of 294 patients in the analysis. We found that ED charges were inversely related to mortality (adjusted OR 0.829 per $1000 increase in total ED charges, 95%CI 0.702–0.980). ED charges were also independently associated with 28-day hospital-free and ICU-free days (0.74 days increase per $1000 additional ED charges, 95%CI 0.06–1.41 and 0.81 days increase per $1000 additional ED charges, 95%CI 0.05–1.56, respectively). ED charges were also associated with APACHE-II score ($34 total ED charges per point increase in APACHE-II score, 95%CI $6–62). Conclusions ED charges in administrative data sets are associated with in-hospital mortality and health care utilization, likely related to both illness severity and intensity of early sepsis resuscitation. ED charges may have a role in risk adjustment models using administrative data for acute care research.

Health Economics

Hospital Administration

Critical illness

Sepsis

Costs and cost analysis

Risk adjustment

Emergency service, hospital

Health services research

OAfund

Details

Title: Subtitle: Emergency department charges may be associated with mortality in patients with severe sepsis and septic shock: a cohort study
Creators: Nicholas M Mohr - University of Iowa, Anesthesia
Ryan Dick-Perez - University of Iowa
Azeemuddin Ahmed - University of Iowa, Emergency Medicine
Karisa K. Harland - University of Iowa, Emergency Medicine
Dan Shane - University of Iowa, Economics
Daniel Miller - University of Iowa
Christine Miyake - St. Rose Dominican Hospital
Levi Kannedy - University of Iowa
Brian M. Fuller - Washington University in St. Louis
James C. Torner - University of Iowa, Epidemiology
Resource Type: Journal article
Publication Details: BMC Emergency Medicine, Vol.18(1), 62
DOI: 10.1186/s12873-018-0212-3
PMID: 30594140
PMCID: PMC6310923
NLM abbreviation: BMC Emerg Med
ISSN: 1471-227X
eISSN: 1471-227X
Publisher: BMC
Grant note: This project is supported by the Emergency Medicine Foundation, the University of Iowa Department of Emergency Medicine, and the University of Iowa Institute for Clinical and Translational Sciences, which is supported by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program, grant U54TR001356. The organizations funding this research did not have any access to data or contribute to the study design or interpretation. The funding organization played no role in the acquisition, analysis, or reporting of this research report. Dr. Mohr is also supported by a grant from the Federal Office of Rural Health Policy. Dr. Fuller was funded by the Washington University KL2 Career Development Award and (KL2 TR000450) from the National Center for Advancing Translational Sciences (NCATS) and the Foundation for Barnes-Jewish Hospital Clinical and Translational Sciences Research Program (Grant # 8041–88). ------------------------ Competing Interests: The authors declare that they have no competing interests.
Language: English
Date published: 12/29/2018
Academic Unit: Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center; Internal Medicine
Record Identifier: 9983761184402771

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