{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T11:21:12Z","timestamp":1791199272741,"version":"4.1.0"},"reference-count":15,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004590","name":"Helse Midt-Norge","doi-asserted-by":"publisher","award":["(2019\/38881)"],"award-info":[{"award-number":["(2019\/38881)"]}],"id":[{"id":"10.13039\/501100004590","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100008900","name":"Helse Nord-Tr\u00f8ndelag","doi-asserted-by":"publisher","award":["2022\/1927, 2022\/31982"],"award-info":[{"award-number":["2022\/1927, 2022\/31982"]}],"id":[{"id":"10.13039\/501100008900","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>In observational studies that use administrative data, it is essential to report technical details such as the number of International Classification of Disease (ICD) coding fields extracted. This information is crucial for ensuring comparability between studies and for avoiding truncation bias in estimates, particularly for complex conditions like sepsis. Specific sepsis codes (explicit sepsis) are suggested to be identified by extracting 15 diagnosis fields, while for implicit sepsis, which comprises an infection code combined with acute organ failure, the number of diagnosis field remains unknown.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The objective was to explore the necessary number of diagnosis fields to capture explicit and implicit sepsis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>We conducted a study utilizing The Norwegian Patient Register (NPR), which encompasses all medical ICD-10 codes from specialized health services in Norway. Data were extracted for all adult patients with hospital discharges registered with explicit and implicit sepsis codes from all Norwegian hospitals between 2008 through 2021.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of 317,705 sepsis admissions, we identified 105,499 ICD-10 codes for explicit sepsis, while implicit sepsis was identified through 270,346 codes for infection in combination with 240,789\u00a0codes for acute organ failure. Through our analysis, we found that 55%, 37%, and 10% of the explicit, infection, and acute organ failure codes, respectively, were documented as the main diagnosis. The proportion of explicit and infection codes peaked in the primary diagnosis field, while for acute organ failure codes, this was true in the third secondary diagnosis field. Notably, the cumulative proportion reached 99% in diagnosis field 10 for explicit codes and in diagnosis field 13 for implicit codes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Expanding the utilization of multiple diagnosis fields can enhance the comparability of data in epidemiological studies, both internationally and within countries. To make truncation bias visible, reporting guidelines should specify the number of diagnosis fields when extracting ICD-10 codes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0320054","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T16:03:08Z","timestamp":1742400188000},"page":"e0320054","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":3,"title":["Number of ICD-10 diagnosis fields required to capture sepsis in administrative data and truncation bias: A nationwide prospective registry study"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6931-007X","authenticated-orcid":true,"given":"Nina Vibeche","family":"Skei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4268-671X","authenticated-orcid":true,"given":"Jan Kristian","family":"Dam\u00e5s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2709-3991","authenticated-orcid":true,"given":"Lise Tuset","family":"Gustad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"issue":"5","key":"pone.0320054.ref001","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1093\/intqhc\/mzu064","article-title":"International variation in the definition of \u201cmain condition\u201d in ICD-coded health data","volume":"26","author":"H Quan","year":"2014","journal-title":"Int J Qual Health Care"},{"key":"pone.0320054.ref002","unstructured":". Importance of ICD-10 2024. n.d."},{"issue":"8","key":"pone.0320054.ref003","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"M Singer","year":"2016","journal-title":"JAMA"},{"issue":"10219","key":"pone.0320054.ref004","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/S0140-6736(19)32989-7","article-title":"Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study","volume":"395","author":"K Rudd","year":"2020","journal-title":"Lancet"},{"issue":"7","key":"pone.0320054.ref005","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1097\/00003246-200107000-00002","article-title":"Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care","volume":"29","author":"DC Angus","year":"2001","journal-title":"Crit Care Med"},{"issue":"1","key":"pone.0320054.ref006","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/intqhc\/mzt090","article-title":"How many diagnosis fields are needed to capture safety events in administrative data? Findings and recommendations from the WHO ICD-11 Topic Advisory Group on Quality and Safety","volume":"26","author":"SE Dr\u00f6sler","year":"2014","journal-title":"Int J Qual Health Care"},{"issue":"1","key":"pone.0320054.ref007","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1186\/s13054-018-2157-z","article-title":"The global burden of sepsis: barriers and potential solutions","volume":"22","author":"KE Rudd","year":"2018","journal-title":"Crit Care"},{"issue":"8","key":"pone.0320054.ref008","doi-asserted-by":"crossref","first-page":"e071846","DOI":"10.1136\/bmjopen-2023-071846","article-title":"Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis in Norwegian hospitals, 2008-2021: a nationwide registry study","volume":"13","author":"N Skei","year":"2023","journal-title":"BMJ Open"},{"issue":"1","key":"pone.0320054.ref009","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/1403494819859737","article-title":"The Norwegian Patient Registry and the Norwegian Registry for Primary Health Care: Research potential of two nationwide health-care registries","volume":"48","author":"IJ Bakken","year":"2020","journal-title":"Scand J Public Health"},{"key":"pone.0320054.ref010"},{"key":"pone.0320054.ref011","year":"2022"},{"issue":"YY","key":"pone.0320054.ref012","first-page":"ZZ-ZZ","article-title":"Trends in mortality after a sepsis hospitalization: a nationwide prospective registry study from 2008 to 2021","volume":"XX","author":"N Skei","year":"2023","journal-title":"Infection"},{"key":"pone.0320054.ref013","author":"network e.","year":"2024"},{"issue":"7","key":"pone.0320054.ref014","doi-asserted-by":"crossref","first-page":"e0198847","DOI":"10.1371\/journal.pone.0198847","article-title":"Comparing the validity of different ICD coding abstraction strategies for sepsis case identification in German claims data","volume":"13","author":"C Fleischmann-Struzek","year":"2018","journal-title":"PLoS One"},{"issue":"16","key":"pone.0320054.ref015","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1056\/NEJMoa022139","article-title":"The epidemiology of sepsis in the United States from 1979 through 2000","volume":"348","author":"GS Martin","year":"2003","journal-title":"N Engl J Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T16:03:32Z","timestamp":1742400212000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0320054"}},"subtitle":[],"editor":[{"given":"Daniel","family":"Antwi-Amoabeng,","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,3,19]]},"references-count":15,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,19]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0320054","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2024.07.03.24309876","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,19]]}}}