Septic Shock: Difference between revisions
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== Data Integrity Rules == | == Data Integrity Rules == | ||
Septic shock (44-00) is mutually exclusive with 45-00 [[Severe Sepsis]]. | Septic shock (44-00) is mutually exclusive with 45-00 [[Severe Sepsis]]. | ||
===Questions=== | |||
{{Discussion}} | |||
#If the 1st criteria for low BP "IS" met but 2nd criteria is "NOT" met (which is tmp >38.5 or HR >90 or RR >20) examples may be patient is either sedated, ventilated, or patient is hypothermic or heart rate is less than 90 for what ever reason, would they still meet the definition of septic shock if only 1st and 3rd criteria (organ failure) are met? OR....do we code as severe sepsis (which includes organ failure but excludes low BP). If so, how do we capture the low BP? Severe sepsis is organ failure but excludes low BP.[[User: GHall |Gail Hall]], [[User: Jpeterson | Joyce Peterson]], [[User: Mlaporte | Marie Laporte]][[User:TOstryzniuk|Trish Ostryzniuk]] 15:52, 2012 June 1 (CDT) | |||
# are any collectors only use the 1st BP criteria (BP<90mmhg) for septic shock? | |||
[[Category: Data Integrity Rules]] | [[Category: Data Integrity Rules]] | ||
[[Category:Diagnosis Coding]] | [[Category:Diagnosis Coding]] |
Revision as of 15:52, 2012 June 1
Legacy Content
This page is about the pre-ICD10 diagnosis coding schema. See the ICD10 Diagnosis List, or the following for similar diagnoses in ICD10:Shock, septicClick Expand to show legacy content.
edit dx infobox | |
Category/Organ System: |
Category: Cardiovascular Problems (old) |
Type: |
[[:Category: Medical Problem (old)]][[Category: Medical Problem (old)]] |
Main Diagnosis: | Septic Shock |
Sub Diagnosis: | SEPTIC SHOCK |
Diagnosis Code: | Septic Shock - 4400 |
Comorbid Diagnosis: | No |
Charlson Comorbid coding (pre ICD10): | 0 |
Program: | Critical Care and Medicine |
Status: | Currently Collected
|
Mutually exclusive with Severe Sepsis
Also see Septicemia definition.
See QA Septic Shock audit started September 2009.
Definition
(1) Blood pressure (BP) criteria
- If at least one of the following is present, code Septic Shock:
- systolic BP < 90 mmHg for > 30 minutes and not responding to fluid resuscitation or
- mean (m)BP < 65 mmHg (is this an "and" to the next line?)
- BP drop of > 40 mmHg from baseline for > 30 min or
- use of vasopressor to maintain systolic BP >= 90 mmHg in the absence of other causes of shock, e.g.:
- no hypovolemia
- no MI
- no pulmonary embolus
- If none of the BP criteria are met:
- see Severe Sepsis
(2) Other Criteria
Plus at least two of:
- temperature > 38.5 C
- HR > 90
- RR > 20
(3) Organ Failure Criteria
Plus at least one of (organ failure):
- Neuro changes: GCS < 14
- Lactic Acidosis: at least one of
- LA > 2.0 or
- PH < 7.30 or
- BE < 10
- Oliguria: at least one of
- urine < 0.5 cc/kg/hr or
- urine output < 30 ml / hr or
- serum creatinine increase > 40 uM from baseline
- Hypoxia: at least one of
- Coagulopathy: drop in platelets > 25% from baseline plus at least one of
- > 25% PT or
- > 25% PTT or
- NR >1.5
Notes
- a positive culture is not required for septic shock
- you can use septic shock to code distributive shock unless it can be coded more accurately:
- causes for distributive shock that should not be coded as septic shock are:
- Anaphylactic Shock
- Neurogenic or Spinal Shock
- causes for distributive shock that should not be coded as septic shock are:
Data Integrity Rules
Septic shock (44-00) is mutually exclusive with 45-00 Severe Sepsis.
Questions
- If the 1st criteria for low BP "IS" met but 2nd criteria is "NOT" met (which is tmp >38.5 or HR >90 or RR >20) examples may be patient is either sedated, ventilated, or patient is hypothermic or heart rate is less than 90 for what ever reason, would they still meet the definition of septic shock if only 1st and 3rd criteria (organ failure) are met? OR....do we code as severe sepsis (which includes organ failure but excludes low BP). If so, how do we capture the low BP? Severe sepsis is organ failure but excludes low BP.Gail Hall, Joyce Peterson, Marie LaporteTrish Ostryzniuk 15:52, 2012 June 1 (CDT)
- are any collectors only use the 1st BP criteria (BP<90mmhg) for septic shock?