Severe sepsis: Difference between revisions

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{{ICD10 transition status

| OldDxArticle =~~Thrombocytopenia~~| CurrentStatus = ~~freshly automatically generated article~~

| OldDxArticle =Severe Sepsis

| CurrentStatus = reconciled

| InitialEditorAssigned = Stephanie Cortilet

~~| MinimumCombinedCodes =2~~

}}

{{ICD10 dx

| MinimumCombinedCodes =2

| ICD10 Code=R65.1

| BugRequired=

| BugRequired= required

}}

== Additional Info ==

*Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016). These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions we have just 2 subcategories:

**Sepsis ~~is life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"~~

**Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone

*For these the cause is proven infection, OR '''presumed''' infection -- thus positive cultures are ''not'' required.

*Do not code this if the patient qualifies as having '''[[Shock, septic]]'''.

*The 2016 consensus group defined the ORGAN DYSFUNCTION as an acute CHANGE from patient's baseline total SOFA score '''by 2 or more points''' -- where the baseline SOFA score can be assumed to be 0 in patients not known to have preexisting organ dysfunction.

*Here is the SOFA scoring:

~~{| border="1" style="border-collapse:collapse"~~

~~| Category||0||1||2||3||4~~

|-

~~| GCS||15||13-14||10-12||6-9||<6~~

|-

~~| Platelets||>=150||<150||<100||<50||<20~~

|-

~~| Serum bilirubin (uM)||<20||20-32||33-101||102-204||>204~~

|-

~~| Serum creatinine (uM)||<110||110-170||171-299||300-440||>440~~

|-

~~| Urine output (mL/day)|| || || ||<500||<200~~

|-

~~| PaO2/FIO2||>=400||<400||<300||<200||<100~~

|-

~~| Cardiovascular||MAP>=70||MAP<70||see note A||see note B||see note C~~

|}

*Note A: dopamine < 5 OR any dose of dobutamine

*Note B: dopamine 5.1-15 OR epi<=0.1 OR norepi<=0.1

*Note C: dopamine >15 OR epi>0.1 OR norepi>0.1

*for these all doses are in microgram/kg/min

== Alternate ICD10s to consider coding instead or in addition ==

*[[~~Severe sepsis~~]]

*[[Sepsis (SIRS due to infection, without acute organ failure)]]

*[[Shock, septic]]

*[[Puerperal (post-delivery) infections or sepsis]]

*[[Shock, NOS]]

*[[Bacteremia]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).

*[[Shock, cardiogenic]]

*[[Shock, hypovolemic shock or hemorrhagic shock]]

*[[Toxic shock syndrome]]

*[[Bacteremia~~, NOS~~]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).

== Candidate [[Combined ICD10 codes]] ==

*Also code the causative infection.

== Related CCI Codes ==

== Reporting ==

For reporting purposes we group our ICD10 Diagnoses by ICD10 chapter. '''Sepsis is an exception to this!''' [[Sepsis (SIRS due to infection, without acute organ failure)]] and [[Severe sepsis]] will be reported as a group outside of the ICD10 chapters.

== Background ==

=== Introduction of ... ===

*Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016). These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions

== Related Articles ==

@@ Line 1: / Line 1: @@
 {{ICD10 transition status
-| OldDxArticle =Thrombocytopenia| CurrentStatus = freshly automatically generated article
+| OldDxArticle =Severe Sepsis
+| CurrentStatus = reconciled
 | InitialEditorAssigned = Stephanie Cortilet
-| MinimumCombinedCodes =2
 }}
 {{ICD10 dx
+| MinimumCombinedCodes =2
 | ICD10 Code=R65.1
-| BugRequired=
+| BugRequired= required
 }}
-{{ICD10 category|Infectious disease}}{{ICD10 category|Cardiovascular}}
+{{ICD10 category|Infectious disease}}{{ICD10 category|Infection requiring pathogen}}{{ICD10 category|Cardiovascular}}
 == Additional Info ==
-*Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016).  These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions we have just 2 subcategories:
+{{ICD10 Guideline Sepsis}}
-**Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"
-**Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone
-*For these the cause is proven infection, OR '''presumed''' infection -- thus positive cultures are ''not'' required.
-*Do not code this if the patient qualifies as having '''[[Shock, septic]]'''.
-*The 2016 consensus group defined the ORGAN DYSFUNCTION as an acute CHANGE from patient's baseline total SOFA score '''by 2 or more points''' -- where the baseline SOFA score can be assumed to be 0 in patients not known to have preexisting organ dysfunction.
-*Here is the SOFA scoring:
-{| border="1"  style="border-collapse:collapse"
-| Category||0||1||2||3||4
-|-
-| GCS||15||13-14||10-12||6-9||<6
-|-
-| Platelets||>=150||<150||<100||<50||<20
-|-
-| Serum bilirubin (uM)||<20||20-32||33-101||102-204||>204
-|-
-| Serum creatinine (uM)||<110||110-170||171-299||300-440||>440
-|-
-| Urine output (mL/day)|| || || ||<500||<200
-|-
-| PaO2/FIO2||>=400||<400||<300||<200||<100
-|-
-| Cardiovascular||MAP>=70||MAP<70||see note A||see note B||see note C
-|}
-*Note A:  dopamine < 5 OR any dose of dobutamine
-*Note B:  dopamine 5.1-15 OR epi<=0.1 OR norepi<=0.1
-*Note C:  dopamine >15 OR epi>0.1 OR norepi>0.1
-*for these all doses are in microgram/kg/min
 == Alternate ICD10s to consider coding instead or in addition ==
-*[[Severe sepsis]]
+*[[Sepsis (SIRS due to infection, without acute organ failure)]]
 *[[Shock, septic]]
 *[[Puerperal (post-delivery) infections or sepsis]]
-*[[Shock, NOS]]
+*[[Bacteremia]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).
-*[[Shock, cardiogenic]]
+{{ListICD10Category | categoryName = shock}}
-*[[Shock, hypovolemic shock or hemorrhagic shock]]
-*[[Toxic shock syndrome]]
-*[[Bacteremia, NOS]] AND [[Fungemia, NOS]] -- these are laboratory manifestations, and while it's OK to code them if present, if you do so you should also code the clinical manifestation (such as sepsis, etc).
 == Candidate [[Combined ICD10 codes]] ==
 *Also code the causative infection.
+{{ICD10 Guideline Infection}}
+== Related CCI Codes ==
+== Reporting ==
+For reporting purposes we group our ICD10 Diagnoses by ICD10 chapter. '''Sepsis is an exception to this!''' [[Sepsis (SIRS due to infection, without acute organ failure)]] and [[Severe sepsis]] will be reported as a group outside of the ICD10 chapters.
+== Background ==
+=== Introduction of ... ===
+*Even though as of November 2017 ICD-10 has not yet been modified to reflect it, we are using the 2016 consensus definition of sepsis and septic shock (JAMA 315(8):801-10, 2016).  These new definitions completely do away with talking about the Systemic Inflammatory Response Syndrome (SIRS). In the 2016 definitions
+{{Data Integrity Check List}}
 == Related Articles ==
 {{Related Articles}}
 {{ICD10 footer}}
 {{EndPlaceHolder}}