{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T04:22:14Z","timestamp":1791433334650,"version":"4.3.3"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T00:00:00Z","timestamp":1765152000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100007653","name":"Universit\u00e4tsklinikum Jena","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100007653","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Infection"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Sepsis is a leading cause of morbidity and mortality, yet its documentation and coding in administrative health data remain unreliable. Accurate coding is essential for epidemiological surveillance, quality assurance, and reimbursement. This study aims to identify patient characteristics associated with under-diagnosis and under-coding of sepsis in German inpatient administrative health data (IAHD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This secondary analysis of the multicenter OPTIMISE study included 10,334 hospital cases from ten German hospitals (2015\u20132017). Sepsis cases were identified via structured chart review and compared to ICD-coded diagnoses. Logistic regression and classification tree analyses were used to determine predictors of under-diagnosis and under-coding, including ICU admission, organ dysfunction, and infection source.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1,310 cases fulfilling severe sepsis-1 criteria, only 30.7% were correctly coded. The strongest predictor for coding accuracy was explicit mention of sepsis in the medical chart (OR 19.58). ICU treatment, organ dysfunction severity, and mechanical ventilation were also associated with higher coding rates, while pneumonia as the infection source was linked to a lower probability of sepsis being named and coded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Sepsis coding in administrative data is frequently inaccurate. Explicit naming of sepsis and severity markers strongly influence correct coding. As Germany introduces mandatory sepsis quality assurance in 2026, targeted interventions \u2013 including enhanced clinician documentation and electronic coding support \u2013 are essential to improve coding reliability and patient care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s15010-025-02685-8","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T07:39:03Z","timestamp":1765179543000},"page":"421-432","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Think sepsis, write sepsis, code sepsis \u2013 patient characteristics associated with sepsis (under-)coding in administrative health 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It was approved by the ethics commission of the Jena University Hospital (No. 2018\u20131065-Daten).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Since only routinely collected clinical data were used, the need for informed consent was waived by the ethics commission of the Jena University Hospital.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent"}},{"value":"Daniel Thomas-R\u00fcddel has no conflict of interest. Norman Rose received funding from the German Innovations Fund of the Federal Joint Committee unrelated to this work. Carolin Fleischmann-Struzek received funding from the German Innovations Fund of the Federal Joint Committee unrelated to this work. Konrad Reinhart received funding for this work by grant 01VSF17010 from the German Innovations Fund of the Federal Joint Committee, is shareholder with less of 0.5% of InflaRx NV a Jena \/Germany based Biotech Company that evaluates a immunmodulatory approach for the adjunctive treatment of COVID-19. Beate Boden has no conflict of interest. Heike Dorow was funded for this work by grant 01VSF17010 from the German Innovations Fund of the Federal Joint Committee. The institution of Andreas Edel received payments or honoraria for lectures and expert testimony from Gilead Sciences GmbH. Andreas Edel hold shares fo BioNTech, Novavax and Bavarian Nordic (<5000\u20ac). Falk (A) Gonnert has no conflict of interest. J\u00fcrgen G\u00f6tz has no conflict of interest. Matthias Gr\u00fcndling has no conflict of interest. Markus Heim has no conflict of interest. Kirill Holbeck has no conflict of interest. Ulrich Jaschinski has no conflict of interest. Christian Koch has no conflict of interest. Christian K\u00fcnzer has no conflict of interest. Khanh Le Ngoc has no conflict of interest. Simone Lindau has no conflict of interest. Ngoc (B) Mehlmann has no conflict of interest. Patrick Meybohm has no conflict of interest. Holger Neb has no conflict of interest. Michael Nordine has no conflict of interest. Dominique Ouart was funded for this work by grant 01VSF17010 from the German Innovations Fund of the Federal Joint Committee. Christian Putensen has no conflict of interest. Michael Sander reports no COI for this work, outside this work he reports a research grant from Edwards Lifesciences. Jens-Christian Schewe reports no COI for this work, outside this work he reports speaker fees by ZOLL Medical Germany, DR\u00c4GER, and Mitsubishi Tanabe Pharma GmbH. Peter Schlattmann has no conflict of interest. G\u00f6tz Schmidt has no conflict of interest. Gerhard Schneider has no conflict of interest. Claudia Spies reports grants from German Federal Joint Committee (Gemeinsamer Bundesausschuss G-BA), German Federal Ministry of Education and Research (BMBF), Philips Electronics Nederland BV, Max-Planck Society, Sintetica GmbH, Dr. F. K\u00f6hler Chemie GmbH, Georg Thieme Verlag, German Federal Ministry for Economic Affairs and Climate Action (BMWI), European Society of Anaesthesiology and Intenisive Care, Stifterverband (non-profit society promoting science and education), Charit\u00e9 inner university grants, Einstein Foundation Berlin, German Aerospace Center (Deutsches Zentrum f\u00fcr Luft- und Raumfahrt e.V. DLR) and German Research Society (Deutsche Forschungsgemeinschaft) during the conduct of the study. In addition, Claudia Spies has different patents and an unpaid leadership or fiduciary role in association of the Scientific Medical Societies in Germany (AMWF), German Research Foundation (Deutsche Forschungsgemeinschaft) and German National Academy of Sciences \u2013 Leopoldina (Deutsche Akademie der Naturforscher Leopoldina e. V.). Ferdinand Steinsberger has no conflict of interest. Christopher Tam has no conflict of interest. Kai Zacharowski declares that the Department of Anaesthesiology, Intensive Care Medicine & Pain Therapy of the University Hospital Frankfurt, Goethe University received support from B. Braun Melsungen, CSL Behring, Fresenius Kabi, and Vifor Pharma for the implementation of Frankfurt\u2018s Patient Blood anagement program. KZ has received honoraria for participation in advisory board meetings for Haemonetics and Vifor and received speaker fees from CSL Behring, Masimo, Pharmacosmos, Boston Scientific, Salus, iSEP, Edwards and GE Healthcare. He is the Principal Investigator of the EU-Horizon 2020 project ENVISION (Intelligent plug-and-play digital tool for real-time surveillance of COVID-19 patients and smart decision-making in Intensive Care Units) and Horizon Europe 2021 project COVend (Biomarker and AI-supported FX06 therapy to prevent progression from mild and moderate to severe stages of COVID-19). Sebastian Zinn has no conflict of interest. Daniel Schwarzkopf was funded for this work by grant 01VSF17010 from the German Innovations Fund of the Federal Joint Committee and received additional funding from this source unrelated to this work; he leads the coordinating bureau of the German Quality Network sepsis\u2013a quality initiative to improve hospital care for sepsis \u2013 and was partly funded via this project from 2015 to 2022.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}]}}