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Table 1 Study and population characteristics: cohort studies

From: Community-onset sepsis and its public health burden: a systematic review

Study ID year [country] Study characteristics Population characteristics Case identification and data source Exposure and follow-up
Esteban 2007 [46] Spain Design: prospective Case definition and criteria used: ACCP/SCCM definitions μ Case report forms Exposure: Not defined
Study setting: ICU, hospital ward Criteria for COS: 83% sepsis patients had a community-acquired infection (no other details given) FU: March 1, 2003 to June 30, 2003
Geographic scope: city/municipal Inclusion criteria: Consecutively admitted patients (age≥18 years) FU duration: 4 months
Recruitment years: March 1, 2003 to June 30, 2003 Description (n sample size): 15,852 (includes n=702 non-severe sepsis cases)
Ginde 2013 [47] The USA Design: retrospective Case definition and criteria used: Severe sepsis as concurrent bacterial or fungal infection plus acute organ dysfunction using ICD-9-CM codes (995.92) for infection and acute organ dysfunction Annual survey of ED visits conducted by the National Centre for Health Statistics (associated with U.S. non-institutional, general and short stay hospitals) Exposure: Age, nursing home residence
Study setting: nursing residence, community-living, ED
FU: 2005 to 2009
Criteria for COS: patients admitted to ED for severe sepsis FU duration: 5 years
Geographic scope: Nationwide Inclusion criteria: adults (≥18 years) who visited ED (with or without infection other than sepsis)
Recruitment years: 2005–2009 Description (n sample size): a nationally representative survey of all ED visits of adults (age ≥ 18 years) in 2005–2009 (n=87,500,000)
Harrison 2006 [11] The UK Design: retrospective Case definition and criteria used: severe sepsis - infection plus ≥3 SIRS criteria and ≥1 organ dysfunction during the 24-hour period The Case Mix Programme Database containing data on demographics, case mix, outcome and activity for admissions. Patient data were abstracted by trained data collectors according to precise rules and definitions Exposure: not defined
Study setting: ICU and combined ICU/HDU FU: December 2001 to January 2005
Criteria for COS: as having severe sepsis during the first 24 hours following admission to the critical care unit
Geographic scope: Nationwide (England, Wales, and Northern Ireland) FU duration: 2 years (2002-2004)
Inclusion criteria: adults (≥16 years) presenting with severe sepsis within 24 hours of admission to critical care
Description (n sample size): n=59,388 (2002), n=59,527 (2003), n=24,905 (2004)
Recruitment years: December 1995 to January 2005
Henriksen 2015a [42] Denmark Design: Prospective Case definition and criteria used: the ACCP/SCCM criteriaμ The hospitals’ patient administrative database and electronic patient records which were manually reviewed. Exposure: age, sex
Study setting: medical ED, ICU, community-based Criteria for COS: Patient had an infection at arrival or developed an infection during the first 48 hours after admission. FU: September 1, 2010 to August 31, 2011
FU duration: 12 months
Geographic scope: city/municipal
Inclusion criteria: adults (≥15 years) admitted to the medical ED or directly to the medical ICU
Description (n sample size): A population-based survey of all adult
Recruitment years: September 1, 2010, to August 31, 2011 patients admitted to the medical ED at Odense University Hospital, Denmark (n=235,598); n=8,358 hospitalisations
Husak 2010 [48] Canada Design: retrospective Case definition and criteria used: Severe sepsis (including septic shock) - sepsis complicated by organ dysfunction in at least one of the six organ systems and the ICD codes Hospital discharge abstract database Exposure: Not defined
Study setting: hospital ward, ED, ICU FU: April 1, 2004 to March 31, 2009
Geographic scope: Nationwide Criteria for COS: the majority (79%) of patients with sepsis were admitted via the EDs, while 12.4% were admitted directly through hospitals FU duration: 5 years
Recruitment years: April 1, 2004 to March 31, 2009
Inclusion criteria: NR
Description (n sample size): sepsis cases n=26,803 (2004-2005), n=30,587 (2008-2009), n for non-cases (all non-sepsis hospitalizations): NR
Nygard 2014 [49] Norway Design: prospective Case definition and criteria used: ACCP/SCCMμ and SCCM/ESICM/ACCP/ATS/SIS Clinical data were registered prospectively until hospital discharge or in-hospital death using predefined case report forms. Information was collected from medical records, patient charts, and the intensive care electronic monitoring system Exposure: not defined
Study setting: ED, ICU, HDU, and combined ICU/HDU FU: January 2008 to December 2008
Criteria for COS: if they developed severe sepsis within 24 hours of admission to the primary institution
FU duration: 12 months
Geographic scope: city/municipal Inclusion criteria: patients > 15 years of age hospitalized due to COS, including patients transferred from affiliated hospitals, if they developed severe sepsis within 24 hours of admission to the primary institution
Recruitment years: January 2008 - December 2008
Description (n sample size): total N hospitalisations (NR); n=220 severe sepsis cases; non-cases (n): 350,000 population
Page 2015 [50] The USA Design: retrospective Case definition and criteria used: severe sepsis was defined using the methodology of Angus et al. identifying hospitalizations with the presence of ICD-9 discharge diagnoses for both a serious infection and organ dysfunction Hospital discharge data from the UHC representing 300 academic and community hospitals across 42 states. Using medical record review, coders assigned discharge diagnoses for each hospitalization Exposure: not defined
Study setting: NR FU: January 1, 2012 to December 31, 2012
Geographic scope: Nationwide
FU duration: 12 months
Recruitment years: January to December 2012 Criteria for COS: Hospitalizations with an infection present at admission were subdivided into healthcare-associated (admitted from nursing facility, receiving home healthcare, or were on haemodialysis prior to admission), community acquired (from the community). Those discharged without infections at admission were categorized as hospital-acquired
Inclusion criteria: all hospital discharges from January 1, 2012 to December 31, 2012
Description (n sample size): n=3,355,753 hospitalisations; non-cases n (population)=NR
Wang 2012 [36] REGARDS-sepsis cohort study The USA Design: prospective Case definition and criteria used: An infection plus ≥ 2 SIRS criteriaμ Structured interviews, in-home visits, lab results, monitoring every 6 months, medical and hospital admission records (clinical and lab data) Exposure: anthropometric, socio-demographic, dietary, and life-style factors, chronic conditions, and statin use
  Study setting: Community-based, hospital ward, ED Criteria for COS: cohort of community-dwelling individuals. The study focused on individuals presenting to the hospital or ED with community-acquired sepsis
  Geographic scope: Nationwide Inclusion criteria: NR
Description (n sample size): Community-dwelling ≥45 years old individuals in the US (n=30,239)
FU: 5 February, 2003 to 31 December, 2012
Recruitment years: 2003-2007
FU duration: ≥ 7 years
Seymour 2012 [51] The USA Design: retrospective Case definition and criteria used: Hospitalization with severe sepsis using the ICD-9-CM (995.92 and 785.52). Criteria for COS: pre-hospital severe sepsis EMS reports computerized database including dispatch, demographic, clinical, and transport data for each incident. EMS data were linked to hospital discharge records Exposure: not defined
Study setting: pre-hospital EMS FU: 2000 to 2009
  FU duration: 10 years
Geographic scope: regional (King County in Washington State) Inclusion criteria: all adult EMS encounters involving non-trauma, non–cardiac arrest patients transported from a scene to a receiving hospital by ground ambulance
Recruitment years: 2000-2009 Description (n sample size): all 2000-2009 EMS encounters in the area of 1.2 million residents (n=407,176)
Wang 2007 [52] The USA Design: retrospective cohort study Case definition and criteria used: the criteria by ACCP/SCCMμ and SCCM/ESICM/ACCP/ATS/SIS; ICD-9 codes 990.90 and 995.92 as sepsis and severe sepsis, respectively The study used the 2001–2004 NHAMCS public use data set which is a national sample of ED and outpatient visits at hospitals across the US Exposure: not defined
  FU: 2001 to 2004
Study setting: ED FU duration: 4 years
Geographic scope: Nationwide Criteria for COS: patients with severe sepsis presenting to ED
Inclusion criteria: adults (≥18 years) presenting to EDs during 2001-2004 (with or without severe sepsis)
Recruitment years: 2001-2004
Description (n sample size): n=113,123 ED visits (sample-based 4 years); 4-year national estimate n=331,531,000 ED visits; annual national estimate n=82,883,000 ED visits
  1. NR not reported, COS community-onset sepsis, ICU intensive care unit, HDU high dependency unit, FU follow-up, SIRS systemic inflammatory response syndrome, REGARDS Reasons for Geographic And Racial Differences in Stroke, MI myocardial infarction, CAD coronary artery disease, DVT deep vein thrombosis, ED emergency department, AF atrial fibrillation, BMI body mass index, WC waist circumference, PAD peripheral artery disease, TV television, NHAMCS National Hospital Ambulatory Medical Care Survey, ICD-9 CM International Classification of Disease, Ninth Revision Clinical Modification, IQR interquartile range, ACCP/SCCM American College of Chest Physicians/Society of Critical Care Medicine, ESICM European Society of Intensive Care Medicine, ATS American Thoracic Society, SIS Surgical Infection Society, ICD-10-CA International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada, CCI Canadian Classification of Health Interventions, EMS emergency medical services
  2. μ International Sepsis Definitions Conference [1]
  3. β REGARDS-sepsis cohort study publications [3238, 40, 41]