Varying Estimates of Sepsis Mortality Using Death Certificates and Administrative Codes--United States, 1999-2014.

Sepsis is a clinical syndrome caused by a dysregulated host response to infection (1). Because there is no confirmatory diagnostic test, the diagnosis of sepsis is based on evidence of infection and clinical judgement. Both death certificates and health services utilization data (administrative claims) have been used to assess sepsis incidence and mortality, but estimates vary depending on the surveillance definition and data source. To highlight the challenges and variability associated with estimating sepsis mortality, CDC compared national estimates of sepsis-related mortality based on death certificates using the CDC WONDER database with published sepsis mortality estimates generated using administrative claims data from hospital discharges reported in the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality (2). During 2004-2009, using data rounded to thousands, the annual range of published sepsis-related mortality estimates based on administrative claims data was 15% to 140% higher (range = 168,000-381,000) than annual estimates generated using death certificate data (multiple causes) (range = 146,000-159,000). Differences in sepsis-related mortality reported using death certificates and administrative claims data might be explained by limitations inherent in each data source. These findings underscore the need for a reliable sepsis surveillance definition based on objective clinical data to more accurately track national sepsis trends and enable objective assessment of the impact of efforts to increase sepsis awareness and prevention.

Impact of coronavirus disease 2019 (COVID-19) on US Hospitals and Patients, April-July 2020.

OBJECTIVE: The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN), the nation's largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020. DESIGN: From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near-real-time daily national and state estimates to be computed. RESULTS: During the pandemic's April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July. CONCLUSIONS: The NHSN hospital capacity estimates served as important, near-real-time indicators of the pandemic's magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.