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Sepsis, the syndrome of life-threatening organ dysfunction that complicates severe infection, is a leading cause of death and disability worldwide.1 A growing recognition of the enormous burden of sepsis has spurred numerous awareness campaigns, quality improvement initiatives and regulatory measures in recent years. Reliably tracking the burden of sepsis is challenging, however, because sepsis is a clinical syndrome based on a constellation of non-specific signs and symptoms and lacks a gold standard for diagnosis.2 Given the substantial resources being dedicated to improving sepsis care and outcomes, a parallel investment in developing robust, high-quality surveillance tools is necessary to understand which initiatives are effective and where best to allocate future resources.
Until recently, sepsis surveillance has primarily been conducted using hospital discharge diagnosis codes. Epidemiological studies using these data have consistently shown dramatic increases in sepsis incidence and declines in case fatality rates over the past several decades.3–5 However, this method is seriously flawed since it requires (1) clinicians to recognise sepsis by identifying that infection is present and responsible for organ dysfunction; (2) clinicians to document sepsis in the medical record and (3) hospital coders to appropriately identify this documentation and assign sepsis as a primary or secondary diagnosis. These steps are subjective and easily biassed by changing diagnosis and coding practices over time. Specifically, education and awareness campaigns, new screening protocols and international guidelines are all constantly encouraging early detection of sepsis and organ dysfunction. This, by design, leads to the diagnosis of ‘sepsis’ in more mildly ill patients that previously might only have been labelled by their specific infection (eg, pneumonia) or non-specific illnesses.6–9 In the USA, where sepsis diagnoses are tied to the highest level of patient complexity and reimbursement, hospitals also have a clear financial incentive to code for sepsis.10 Diagnosing …