Understanding the biases to sepsis surveillance and quality assurance caused by inaccurate coding in administrative health data

Purpose Timely and accurate data on the epidemiology of sepsis are essential to inform policy decisions and research priorities. We aimed to investigate the validity of inpatient administrative health data (IAHD) for surveillance and quality assurance of sepsis care. Methods We conducted a retrospective validation study in a disproportional stratified random sample of 10,334 inpatient cases of age ≥ 15 years treated in 2015–2017 in ten German hospitals. The accuracy of coding of sepsis and risk factors for mortality in IAHD was assessed compared to reference standard diagnoses obtained by a chart review. Hospital-level risk-adjusted mortality of sepsis as calculated from IAHD information was compared to mortality calculated from chart review information. Results ICD-coding of sepsis in IAHD showed high positive predictive value (76.9–85.7% depending on sepsis definition), but low sensitivity (26.8–38%), which led to an underestimation of sepsis incidence (1.4% vs. 3.3% for severe sepsis-1). Not naming sepsis in the chart was strongly associated with under-coding of sepsis. The frequency of correctly naming sepsis and ICD-coding of sepsis varied strongly between hospitals (range of sensitivity of naming: 29–71.7%, of ICD-diagnosis: 10.7–58.5%). Risk-adjusted mortality of sepsis per hospital calculated from coding in IAHD showed no substantial correlation to reference standard risk-adjusted mortality (r = 0.09). Conclusion Due to the under-coding of sepsis in IAHD, previous epidemiological studies underestimated the burden of sepsis in Germany. There is a large variability between hospitals in accuracy of diagnosing and coding of sepsis. Therefore, IAHD alone is not suited to assess quality of sepsis care

CLONETS-DS – Clock Network Services-Design study Strategy and Innovation for Clock Services Over Optical-fibre Networks

International audienc

CLONETS-DS – Clock Network Services-Design study Strategy and Innovation for Clock Services Over Optical-fibre Networks

International audienc

Visualisation and analysis of shear-deformation bands in unconsolidated Pleistocene sand using ground-penetrating radar: Implications for paleoseismological studies

Deformation bands in unconsolidated sediments are of great value for paleoseismological studies in sedimentary archives. Using ground-penetrating radar (GPR), we investigated an array of shear-deformation bands that developed in unconsolidated Pleistocene glacifluvial Gilbert-type delta sediments. A dense grid (spacing 0.6 m) of GPR profiles was measured on top of a 20 m-long outcrop that exposes shear-deformation bands. Features in the radargrams could be directly tied to the exposure. The shear-deformation bands are partly represented by inclined reflectors and partly by the offset of reflections at delta clinoforms. 3-D interpretation of the 2-D radar sections shows that the bands have near-planar geometries that can be traced throughout the entire sediment volume. Thin sections of sediment samples show that the analysed shear-deformation bands have a denser grain packing than the host sediment. Thus they have a lower porosity and smaller pore sizes and therefore, in the vadose zone, the deformation bands have a higher water content due to enhanced capillary forces. This, together with the partially-developed weak calcite cementation and the distinct offset along the bands, are likely the main reasons for the clear and unambiguous expression of the shear-deformation bands in the radar survey. The study shows that deformation-band arrays can clearly be detected using GPR and quickly mapped over larger sediment volumes. With the 3-D analysis, it is further possible to derive the orientation and geometry of the bands. This allows correlation of the bands with the regional fault trend. Studying deformation bands in unconsolidated sediments with GPR is therefore a powerful approach in paleoseismological studies. Based on our data, we postulate that the outcrop is part of a dextral strike-slip zone that was reactivated by glacial isostatic adjustmen