Severe sepsis: Difference between revisions
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m Agarland moved page Severe sepsis (SIRS due to infection with acute organ failure) to Severe sepsis without leaving a redirect |
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*Even though 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). | *Even though 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: | *In the 2016 definitions we have just 2 subcategories: | ||
**Sepsis | **Sepsis = life-threatening '''organ dysfunction''' caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis" | ||
**Septic shock | **Septic shock = a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. | ||
*Shock refers to: absolute or relative hypotension OR systemic evidence of hypoperfusion (e.g. organ failure(s), elevated serum lactate). | ***Shock refers to: absolute or relative hypotension OR systemic evidence of hypoperfusion (e.g. organ failure(s), elevated serum lactate). | ||
* | **To qualify for these, you need proven ''or presumed'' infection -- thus positive cultures are '''not''' required. | ||
*The 2016 consensus group defined the ORGAN DYSFUNCTION as: | |||
**An acute CHANGE from patient's baseline total SOFA score>2 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: | |||
** 0 1 2 3 4 | |||
**-------------------------------------------------------------------------------- | |||
**PaO2/FIO2 >=400 <400 <300 <200 <100 | |||
**Platelet count >=150 <150 <100 <50 <20 | |||
**Serum bilirubin (uM) <20 20-32 33-101 102-204 >204 | |||
**Cardiovascular MAP>=70 MAP<70 | |||
**GCS 15 13-14 10-12 6-9 <6 | |||
**Serum creatinine (uM) <110 110-170 171-299 300-440 >440 | |||
**Urine output (mL/day) <500 <200 | |||
== Alternate ICD10s to consider coding instead or in addition == | == Alternate ICD10s to consider coding instead or in addition == | ||
*[[Sepsis (SIRS due to infection, without acute organ failure)]] | *[[Sepsis (SIRS due to infection, without acute organ failure)]] | ||
*[[Severe sepsis | *[[Severe sepsis]] | ||
*[[Shock, septic]] | *[[Shock, septic]] | ||
*[[Puerperal (post-delivery) infections or sepsis]] | *[[Puerperal (post-delivery) infections or sepsis]] | ||
Revision as of 06:30, 2017 November 2
| 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 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 = life-threatening organ dysfunction caused by a dysregulated host response to infection -- NOTE this was the 2001 definition of "severe sepsis"
- Septic shock = a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.
- Shock refers to: absolute or relative hypotension OR systemic evidence of hypoperfusion (e.g. organ failure(s), elevated serum lactate).
- To qualify for these, you need proven or presumed infection -- thus positive cultures are not required.
- The 2016 consensus group defined the ORGAN DYSFUNCTION as:
- An acute CHANGE from patient's baseline total SOFA score>2 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:
- 0 1 2 3 4
- --------------------------------------------------------------------------------
- PaO2/FIO2 >=400 <400 <300 <200 <100
- Platelet count >=150 <150 <100 <50 <20
- Serum bilirubin (uM) <20 20-32 33-101 102-204 >204
- Cardiovascular MAP>=70 MAP<70
- GCS 15 13-14 10-12 6-9 <6
- Serum creatinine (uM) <110 110-170 171-299 300-440 >440
- Urine output (mL/day) <500 <200
Alternate ICD10s to consider coding instead or in addition
- Sepsis (SIRS due to infection, without acute organ failure)
- Severe sepsis
- Shock, septic
- Puerperal (post-delivery) infections or sepsis
- Shock, NOS
- 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 Articles
Show all ICD10 Subcategories