Updated on SoS - Introducing CARIS

Introducing CARMIS - Codes of Antibiotic Responsive Medical Infections associated with Sepsis.


In a previous blog I developed the work on SoS codes of Matt Inada-Kim to focus on those codes that are are associated with high mortality infections. Having just completed the first GIRFT deep dive, this concept worked, but was clear it needs development. The first is with the "branding", and we need a new name that more clearly distinguishes this from sepsis, and makes it clear that it is derived from Hospital Episode Statistics. I also felt we needed more categories, to make the reasoning clearer. It is hard to know how to deal with things like aspiration pneumonia and COPD. These have amongst the highest mortalities of any common disease, but it is debatable how much antibiotics contribute to management. Similarly, surgical conditions that are principally managed through intervention (certainly perforation, but also probably cholangitis) muddy the waters. My latest feeling is we need more categories.

1. Codes for sepsis admissions (CSA)

The following are the most common sepsis related codes, with national frequency and in-patient mortality.

Sepsis - overall 2615 16%
A41.9 - Sepsis, unspecified 1882 15%
A41.5 - Sepsis due to other Gram-negative organisms 360 11%
A41.8 - Other specified sepsis 87 37%
A41.0 - Sepsis due to Staphylococcus aureus 70 34%
A41.1 - Sepsis due to other specified staphylococcus 40 23%
A40.8 - Other streptococcal sepsis 34 18%
J15.0 - Pneumonia due to Klebsiella pneumoniae 27 30%
A40.9 - Streptococcal sepsis, unspecified 21 14%
R57.2 - Septic shock 21 52%
A49.9 - Bacterial infection, unspecified 19 16%
A41.2 - Sepsis due to unspecified staphylococcus 19 21%
A40.0 - Sepsis due to streptococcus, group A 19 21%
A40.3 - Sepsis due to Streptococcus pneumoniae 16 13%

2. Codes for antibiotic responsive medical infections associated with sepsis (CARMIS)

(more than 500 cases + mortality >=2%; or clear infective cause identified with mortality>5%)

As above, but also including :

Pneumonia 15648 13%
J22.X - Unspecified acute lower respiratory infection 3808 4%
J18.9 - Pneumonia, unspecified 3126 15%
J18.0 - Bronchopneumonia, unspecified 432 56%
J13.X - Pneumonia due to Streptococcus pneumoniae 112 10%
J15.1 - Pneumonia due to Pseudomonas 51 27%
J18.1 - Lobar pneumonia, unspecified 5265 19%
UTI 7088 4%
 N39.0 - Urinary tract infection, site not specified 7088 4%
Skin, soft tissue, bone 3021 2%
L03.1 - Cellulitis of other parts of limb 2983 2%
3. Common high mortality medical conditions in which antibiotics are adjunctive (CHiMoMCAA)
(more than 500 cases and mortality >2%)

J44.0 - Chronic obstructive pulmonary disease with acute lower respiratory infection 2854 6.40%
J69.0 - Pneumonitis due to food and vomit 776 33.50%

4. Surgical conditions associated with sepsis (SCAS)

Coding seems particular poor for these, with no condition having more than 500 codes.


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