Severe sepsis: Difference between revisions
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{{Discuss | who = Allan| question = | {{Discuss | who = Allan| question = | ||
*What are the specific criteria to define severe sepsis?--[[User:Jpeterson|Jpeterson]] 08:42, 2018 December 3 (CST) | *What are the specific criteria to define severe sepsis?--[[User:Jpeterson|Jpeterson]] 08:42, 2018 December 3 (CST) | ||
*AG REPLY --- acute failure of one of more organs in the setting of infection, and presumably due to the infection. The official definition of this per the SEPSIS-3 guidelines is an acute increase in the SOFA score by 2 or more. https://en.wikipedia.org/wiki/SOFA_score. SOFA is made up scoring from 6 organs: pulmonary, coagulation, liver, CV, | *AG REPLY --- acute failure of one of more organs in the setting of infection, and presumably due to the infection. The official definition of this per the SEPSIS-3 guidelines is an acute increase in the SOFA score by 2 or more. https://en.wikipedia.org/wiki/SOFA_score. SOFA is made up scoring from 6 organs: pulmonary, coagulation, liver, CV, CNS and renal, as indicated below.}} | ||
*Do not code this if the patient qualifies as having '''[[Shock, septic]]'''. | *Do not code this if the patient qualifies as having '''[[Shock, septic]]'''. | ||
Revision as of 10:35, 2018 December 9
| ICD10 Diagnosis | |
| Dx: | Severe sepsis |
| ICD10 code: | R65.1 |
| Pre-ICD10 counterpart: | Severe Sepsis |
| Charlson/ALERT Scale: | none |
| APACHE Como Component: | none |
| APACHE Acute Component: | 2019-0: Sepsis |
| Start Date: | |
| Stop Date: | |
| External ICD10 Documentation | |
This diagnosis is a part of ICD10 collection.
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.
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- 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.
- GO TO: SOFA scoring:
Alternate ICD10s to consider coding instead or in addition
- Sepsis (SIRS due to infection, without acute organ failure)
- Shock, septic
- Puerperal (post-delivery) infections or sepsis
- 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 codes: |
Candidate Combined ICD10 codes
- Also code the causative infection.
Infections
Infections in ICD10 have combined coding requirements for some of their pathogens. Any that have antibiotic resistances would store those as Combined ICD10 codes as well. If the infection is acquired in the hospital, see Nosocomial infection, NOS. See Lab and culture reports for confirmation and details about tests. See Infections in ICD10 for more general info.
Possible Simultaneous Presence of Multiple Different Types of Infection in a Single Site
- This refers to the situation where there may be simultaneous infection with multiple types of organisms -- e.g. 2 of bacteria, virus, fungus. While a classic example is a proven viral pneumonia (e.g. influenza) with a suspected/possible bacterial pneumonia superimposed, this kind of thing can occur in places other than the lungs, e.g. meningitis.
- The "signature" of this is typically the patient being treated simultaneously with antimicrobial agents for multiple types of organisms. BUT don't confuse this with there being infections at DIFFERENT body sites.
- As per our usual practice, we will consider a diagnosis as present if the clinical team thinks it's present and are treating it, with the exception that the team initially treated for the possible 2nd type of infection but then decided it likely was NOT present and stopped those agents.
- And remember that Infectious organism, unknown is used when the the specific organism is unknown (this could be not knowing the TYPE of organism, or suspecting the type but not having identified the specific organism of that type), while when the organism has been identified but it's not in our bug list, THEN use Bacteria, NOS, Virus, NOS or Fungus or yeast, NOS.
Attribution of infections
Related CCI Codes
Data Integrity Checks (automatic list)
| App | Status | |
|---|---|---|
| Query check ICD10 Inf Infection req Pathogen must have one | CCMDB.accdb | implemented |
| Query Check Inf Pathogens must have Infection requiring pathogen or Potential Infection | CCMDB.accdb | implemented |
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Show all ICD10 Subcategories