International Classification of Diseases, Ninth Edition (ICD-9) Codes Associated with An

ED Sepsis - Appendices

Page 1 of 9

APPENDIX 1

International Classification of Diseases, ninth edition (ICD-9) codes associated with an infection.12,17,18

Infection Category / ICD-9 Code / ICD-9 Code Description
Parasitic / 001 / Cholera
002 / Typhoid/paratyphoid fever
003 / Other salmonella infection
004 / Shigellosis
005 / Other food poisoning
008 / Intestinal infections due to Escherichia coli
008.1 / Intestinal infections due to Arizona group of paracolon bacillus
008.2 / Intestinal infections due to Aerobacter aerogenes
008.3 / Intestinal infections due to Proteus (mirabilis morganii)
008.4 / Intestinal infections due to unspecified bacteria
008.5 / Bacterial enteritis, unspecified
009 / Ill-defined intestinal infection
013 / CNS tuberculosis
018 / Miliary tuberculosis
020 / Plague
021 / Tularemia
022 / Anthrax
023 / Brucellosis
024 / Glanders
025 / Melioidosis
026 / Rat-bite fever
027 / Other bacterial zoonoses
032 / Diphtheria
033 / Whooping cough
034 / Streptococcal throat/scarlet fever
035 / Erysipelas
036 / Meningococcal infection
037 / Tetanus
038 / Septicemia
039 / Actinomycotic infections
040 / Other bacterial diseases
041 / Bacterial infection in other diseases not specified
098 / Gonococcal infections
100 / Leptospirosis
101 / Vincent’s angina
112 / Candidiasis, of mouth
112.4 / Candidiasis, of lung
112.5 / Candidiasis, disseminated

APPENDIX 1 (con’t)

Infection Category / ICD-9 Code / ICD-9 Code Description
112.8 / Candidiasis, of other specified sites
114 / Coccidioidomycosis
115 / Histoplasmosis
116 / Blastomycotic infection
117 / Other mycoses
118 / Opportunistic mycoses
Nervous / 320 / Bacterial meningitis
321 / Cryptococcal meningitis
321.1 / Meningitis in other fungal diseases
324 / CNS abcess
325 / Phlebitis of intracranial sinus
360 / Purulent endophthalmitis
376 / Acute inflammation of orbit
380.14 / Malignant otitis externa
383 / Acute mastoiditis
Circulatory / 420.99 / Acute pericarditis due to other specified organisms
421 / Acute or subacute endocarditis
Respiratory / 461 / Acute sinusitis
462 / Acute pharyngitis
463 / Acute tonsillitis
464 / Acute laryngitis/tracheitis
465 / Acute upper respiratory infection of multiple sites/not otherwise specified
475 / Peritonsillar abscess
481 / Pneumococcal pneumonia
482 / Other bacterial pneumonia
485 / Bronchopneumonia with organism not otherwise specified
486 / Pneumonia, organism not otherwise specified
491.21 / Acute exacerbation of obstructive chronic bronchitis
494 / Bronchiectasis
510 / Empyema
513 / Abscess of lung and mediastinum
Digestive / 522.5 / Periapical abscess without sinus
522.7 / Periapical abscess with sinus
526.4 / Inflammatory conditions of the jaw
527.3 / Abscess of the salivary glands
528.3 / Cellulitis and abscess of oral soft tissue
540 / Acute appendicitis

APPENDIX 1 (con’t)

Infection Category / ICD-9 Code / ICD-9 Code Description
541 / Appendicitis not otherwise specified
542 / Other appendicitis
562.01 / Diverticulitis of the small intestine without hemorrhage
562.03 / Diverticulitis of the small intestine with hemorrhage
562.11 / Diverticulitis of colon without hemorrhage
562.13 / Diverticulitis of colon with hemorrhage
566 / Abscess of the anal and rectal regions
567 / Peritonitis
569.5 / Intestinal abscess
569.61 / Infection of colostomy or enterostomy
569.83 / Perforation of intestine
572 / Abscess of liver
572.1 / Portal pyemia
575 / Acute cholecystitis
Genitourinary / 590 / Kidney infection
599 / Urinary tract infection not otherwise specified
601 / Prostatic inflammation
604 / Orchitis and epididymitis
614 / Female pelvic inflammation disease
615 / Uterine inflammatory disease
616.3 / Abscess of Bartholin’s gland
616.4 / Other abscess of vulva
Pregnancy / 634 / Spontaneous abortion, complicated by genital tract and pelvic infection
635 / Legally induced abortion, complicated by genital tract and pelvic infection
636 / Illegally induced abortion, complicated by genital tract and pelvic infection
637 / Unspecified abortion, complicated by genital tract and pelvic infection
638 / Failed attempted abortion, complicated by genital tract and pelvic infection
639 / Complications following abortion and ectopic and molar pregnancies
646.6 / Infections of genitourinary tract in pregnancy
658.4 / Infection of amniotic cavity
670 / Major puerperal infection
675.1 / Abscess of breast
Skin / 681 / Cellulitis, finger/toe
682 / Other cellulitis or abscess
683 / Acute lymphadenitis
685 / Pilonidal cyst, with abscess

APPENDIX 1 (con’t)

Infection Category / ICD-9 Code / ICD-9 Code Description
686 / Other local skin infection
Musculoskeletal / 711 / Pyogenic arthritis
728.86 / Necrotizing fasciitis
730 / Osteomyelitis
Other / 790.7 / Bacteremia
958.3 / Posttraumatic wound infection, not elsewhere classified
996.6 / Infection or inflammation of device/graft
998.5 / Postoperative infection
999.3 / Infectious complication of medical care not otherwise classified

APPENDIX 2

International Classification of Diseases, ninth edition (ICD-9) codes associated with organ dysfunction.12,17,18

Organ Dysfunction Category / ICD-9 Code / ICD-9 Code Description
Cardiovascular / 458 / Orthostatic hypotension
458.8 / Other specified hypotension
458.9 / Hypotension, unspecified
785.5 / Shock without mention of trauma
Hematologic / 286.6 / Defribrination syndrome
286.8 / Other and unspecified coagulation defects
287.4 / Secondary thrombocytopenia
287.5 / Thrombocytopenia, unspecified
Hepatic / 570 / Acute and subacute necrosis of liver
573.4 / Hepatic infarction
Neurologic / 293 / Transient organic psychosis
348.1 / Anoxic brain damage
348.3 / Encephalopathy
Renal / 584 / Acute renal failure
Respiratory / 518.8 / Respiratory Failure
786.03 / Apnea
799.1 / Respiratory Arrest

APPENDIX 3

Characteristics of United States Emergency Department (ED) adult sepsis visits, 2009-2011. Includes age ≥18 years only. Sepsis classifications provided in Table 1.

Infection or Organ Dysfunction / Original
ED Sepsis
Annual
N=665,319
% (95% CI) / qSOFA
ED Sepsis
Annual N=318,832
% (95% CI) / Revised
ED Sepsis
Annual
N=847,868
% (95% CI)
Infection / 98.8 (97.1-99.5) / 100.0 / 99.0 (97.8-99.6)
Fever (triage body temperature >38 ⁰C or <36 ⁰C) / 44.8 (38.6-51.1) / 49.1 (41.2-57.1) / 45.5 (40.1-51.0)
Serious Infection Diagnosis / 67.3 (61.0-73.1) / 70.7 (62.7-77.6) / 69.0 (63.5-74.0)
Infectious/Parasitic Diseases / 12.2 (8.8-16.7) / 16.5 (11.1-23.8) / 12.9 (9.9-16.7)
Respiratory System Infections / 31.7 (26.7-37.1) / 35.1 (28.2-42.7) / 33.9 (29.2-38.9)
Digestive System Infections / 4.6 (2.9-7.2)* / 3.8 (1.7-8.2)* / 3.8 (2.4-5.9)*
Genitourinary System Infections / 18.9 (15.2-23.4) / 19.6 (13.2-28.0) / 19.0 (15.3-23.4)
Infectious Complications of Pregnancy, Childbirth, Puerperium / 0.8 (0.2-2.5)* / 1.4 (0.4-5.1)* / 1.2 (0.5-2.7)*
Skin and Subcutaneous Tissue Infections / 3.3 (1.7-6.2)* / 2.5 (1.2-5.4)* / 3.3 (1.9-5.6)*
Organ Dysfunction / 99.8 (99.4-100.0) / 100.0 / 99.9 (99.5-100.0)
Organ Dysfunction Diagnosis Codes / 52.6 (46.5-58.6) / 14.2 (9.1-21.5) / 41.3 (35.9-46.8)
Cardiovascular / 13.5 (10.2-17.6) / 8.0 (4.4-14.0)* / 10.6 (8.1-13.8)
Hematologic / 5.1 (3.1-8.2)* / 1.3 (0.4-4.1)* / 4.0 (2.4-6.5)*
Hepatic / 0.5 (0.1-1.5)* / 0 / 0.4 (0.1-1.1)*
Neurologic / 3.6 (1.6-7.6)* / 0 / 2.8 (1.3-6.1)*
Renal / 12.7 (8.9-17.9) / 3.1 (1.2-7.4)* / 10.0 (6.9-14.2)
Pulmonary / 18.1 (14.1-22.8) / 2.4 (0.9-6.7)* / 14.2 (11.0-18.0)
Endotracheal Intubation / 8.6 (6.0-12.1) / 4.2 (1.9-8.7)* / 6.7 (4.7-9.4)
SBP ≤90 mmHg / 48.5 (42.6-54.5) / 32.7 (25.4-41.0) / 38.1 (32.9-43.5)
≥2 qSOFA Criteria / 20.7 (16.7-25.4) / 100.0 / 37.8 (32.7-43.2)
qSOFA Glasgow Coma Score (GCS ≤13) / 30.9 (22.2-41.2) / 76.5 (65.5-84.9) / 48.8 (40.0-57.8)
qSOFA Respiratory (respiratory rate ≥22 breaths/min) / 31.3 (26.0-37.2) / 85.1 (78.7-89.8) / 43.4 (38.3-48.7)
qSOFA Blood Pressure (systolic blood pressure ≤100 mmHg) / 52.3 (46.4-58.2) / 68.3 (59.2-76.2) / 53.2 (47.6-58.7)
Diagnosis of Severe Sepsis or Septic Shock / 4.0 (2.5-6.5)* / 3.3 (1.3-7.8)* / 3.2 (1.9-5.1)*

APPENDIX 4

Characteristics of United States Emergency Department (ED) adult sepsis visits using different ED Sepsis classifications, 2009-2011. *Estimates based upon <30 raw observations.

Characteristic / Original ED Sepsis
Annual N= 665,319
% (95% CI) / qSOFA ED Sepsis
Annual N=318,832
% (95% CI) / Revised ED Sepsis
Annual N= 847,868
% (95% CI)
Age
18-24 / 6.1 (3.9-9.4)* / 3.1 (1.4-6.9)* / 5.8 (3.9-8.5)
25-44 / 11.0 (8.1-14.9) / 7.0 (4.1-11.6)* / 10.3 (7.8-13.6)
45-64 / 30.9 (25.9-36.5) / 29.5 (22.4-37.8) / 31.2 (26.5-36.4)
65-74 / 17.1 (12.7-22.7) / 23.7 (17.4-31.6) / 17.8 (13.9-22.4)
≥75 / 34.8 (29.4-40.7) / 36.7 (28.8-45.4) / 35.0 (30.0-40.2)
Sex
Male / 46.2 (40.8-51.7) / 47.9 (40.4-55.4) / 44.7 (40.2-49.3)
Female / 53.8 (48.3-59.2) / 52.1 (44.6-59.6) / 55.3 (50.7-59.9)
Race
White / 79.3 (73.8-83.8) / 81.4 (73.1-87.7) / 79.6 (74.5-84.0)
Black / 17.4 (13.1-22.6) / 15.7 (10.3-23.1) / 17.2 (13.2-22.0)
Other / 3.4 (1.8-6.2)* / 2.9 (1.1-7.4)* / 3.2 (1.8-5.7)*
Ethnicity
Hispanic / 6.7 (4.5-9.9) / 6.7 (3.9-11.2)* / 6.9 (4.9-9.7)
Non-Hispanic / 93.3 (90.1-95.5) / 93.3 (88.8-96.1) / 93.1 (90.3-95.1)
Arrival by EMS
Yes / 55.7 (49.4-61.8) / 64.9 (56.9-72.1) / 57.0 (51.8-62.0)
No / 39.6 (33.6-46.0) / 31.3 (24.2-39.4) / 38.6 (33.7-43.8)
Unknown / 4.7 (2.2-9.5)* / 3.8 (1.5-9.7)* / 4.4 (2.3-8.3)*
Hospital Geographic Region
Northeast / 19.3 (13.0-27.6) / 15.7 (9.4-25.0) / 18.4 (12.2-26.7)
Midwest / 25.4 (17.9-34.7) / 24.3 (15.9-35.2) / 23.7 (16.8-32.2)
South / 37.4 (28.9-46.9) / 39.6 (28.5-52.0) / 38.4 (29.9-47.7)
West / 17.9 (12.1-25.7) / 20.4 (13.0-30.6) / 19.6 (13.5-27.5)
Patient Residence Population Setting
MSA / 82.4 (70.6-90.1) / 78.6 (65.2-87.8) / 81.6 (70.0-89.3)
Non-MSA / 17.6 (9.9-29.4) / 21.4 (12.2-34.8) / 18.4 (10.7-30.0)
Arrival Time
Day (0700-1459) / 48.2 (42.9-53.5) / 49.0 (40.7-57.3) / 48.7 (43.8-53.6)
Evening (1500-2259) / 35.9 (30.4-41.8) / 34.7 (27.5-42.8) / 35.2 (30.4-40.3)
Night (2300-0659) / 15.9 (12.6-19.7) / 16.3 (11.9-22.0) / 16.1 (13.3-19.5)
Patient Seen in ED in Last 72 Hours
Yes / 4.4 (2.6-7.3)* / 3.2 (1.5-6.8)* / 4.3 (2.6-6.9)
No / 78.9 (71.6-84.8) / 84.7 (76.8-90.2) / 80.9 (74.4-86.0)
Unknown / 16.7 (11.3-23.9) / 12.1 (7.2-19.8)* / 14.9 (10.1-21.3)
Prior Medical History
Stroke / 12.3 (8.5-17.4) / 11.0 (6.5-18.0)* / 11.0 (7.8-15.2)
Congestive Heart Failure / 17.9 (13.9-22.8) / 15.0 (10.1-21.7) / 17.1 (13.5-21.3)
Dialysis / 6.5 (3.7-11.1)* / 6.3 (3.4-11.3)* / 6.2 (3.7-10.0)
HIV / 1.0 (0.3-2.9)* / 1.5 (0.3-7.4)* / 1.3 (0.5-3.4)*
Diabetes / 25.8 (20.7-31.6) / 20.4 (14.4-28.1) / 23.6 (19.4-28.4)
Triage Pulse
0-40 bpm / 0.3 (0.1-1.0)* / 0 / 0.2 (0.1-0.7)*
41-80 / 33.1 (28.0-38.6) / 24.8 (18.2-32.9) / 31.2 (26.7-36.0)
81-120 / 49.9 (44.3-55.5) / 51.8 (43.7-59.7) / 52.0 (47.0-57.0)
≥120 / 14.0 (10.7-18.0) / 21.5 (15.9-28.4) / 13.9 (11.1-17.1)
Unknown / 2.8 (1.6-5.0)* / 1.9 (0.7-4.9)* / 2.8 (1.6-4.8)*
Triage Respiratory Rate
0-6 breaths/min / 0.5 (0.1-1.6)* / 0 / 0.4 (0.1-1.3)*
7-12 / 4.2 (2.5-7.1)* / 1.9 (0.6-6.5)* / 3.4 (2.0-5.6)*
13-20 / 59.0 (53.3-64.6) / 12.5 (8.1-18.7)* / 48.7 (43.5-54.0)
21-30 / 27.2 (22.2-32.8) / 75.0 (68.0-80.9) / 37.9 (32.9-43.1)
>30 / 4.6 (3.0-6.9) / 10.1 (6.5-15.3)* / 5.9 (4.2-8.2)
Unknown / 4.5 (2.8-7.3)* / 0.5 (0.1-3.5)* / 3.8 (2.4-5.9)*
Triage Systolic Blood Pressure
0-80 mmHg / 13.2 (10.1-16.9) / 14.7 (9.9-21.4) / 10.3 (8.0-13.2)
81-100 / 39.2 (33.3-45.4) / 53.6 (45.7-61.3) / 42.9 (37.6-48.3)
101-120 / 14.6 (10.9-19.4) / 11.6 (6.1-21.2)* / 15.0 (11.3-19.7)
≥120 / 30.2 (25.4-35.6) / 20.0 (14.7-26.8) / 29.6 (25.0-34.6)
Unknown / 2.8 (1.5-5.4)* / 0 / 2.2 (1.1-4.3)*
Length of ED Stay
0-2 hours / 14.2 (11.0-18.1) / 12.0 (7.3-19.2) / 13.0 (10.2-16.5)
>2-4 / 32.1 (26.3-38.4) / 35.7 (28.4-43.6)* / 31.8 (26.7-37.4)
>4-8 / 40.9 (35.3-46.7) / 37.9 (30.7-45.8) / 41.6 (36.5-46.9)
>8 / 9.5 (6.7-13.5) / 11.2 (6.7-18.2)* / 10.6 (7.7-14.3)
Unknown / 3.4 (1.8-6.3)* / 3.2 (1.6-6.5)* / 3.1 (1.7-5.4)*

APPENDIX 5

Adult Emergency Department (ED) sepsis visit outcomes, stratified bysepsis classification patterns, 2009-2011. *Estimates based upon <30 raw observations.

Outcome / qSOFA Yes / Original No
Annual N=182,549 / qSOFA No /
Original Yes
Annual N=529,036 / qSOFA Yes /
Original Yes
Annual N=136,283 / p-value
% (95% CI) / % (95% CI) / % (95% CI)
ED Disposition
Discharged Home / 27.7 (18.4-39.4) / 27.5 (21.2-34.9) / 14.4 (6.5-29.0)* / 0.04
Admitted: Non-ICU / 52.4 (40.1-64.5) / 43.2 (35.8-50.9) / 40.1 (27.7-54.0)
Admitted: ICU / 19.9 (12.2-30.7)* / 29.3 (23.7-35.7) / 45.4 (32.3-59.2)
Mortality
Overall Death / 7.4 (3.3-16.0)* / 11.5 (8.1-16.2) / 12.6 (7.3-20.8)* / 0.47