Trends in nationwide hospital-discharge diagnoses belie the accuracy of claims codes in monitoring sepsis rates (see graph
Hospitalizations for Which Certain Infection Codes Were Listed as a Primary Diagnosis, 2003–2011.
). Claims data show a steady increase in the rate of hospitalizations for sepsis, but they show stable or decreasing rates of hospitalizations for the infections that most commonly cause sepsis (pneumonia, urinary tract infections, intraabdominal infections, and bacteremia). Other claims-based analyses suggest that rising sepsis rates have been accompanied by a steady decrease in sepsis-related mortality rates.4 Although decreasing mortality rates may be due to improvements in care, it is also possible that progressively more sensitive coding is capturing a larger but less severely ill group of patients over time. These incongruities raise the possibility that the apparent surge in incidence over the past decade may be at least partly due to changes in coding practices rather than a true increase in sepsis rates