Positive predictive value of International Classification of Diseases, 10 th revision, diagnosis codes for cardiogenic, hypovolemic, and septic shock in the Danish National Patient Registry

Marie Dam Lauridsen; Henrik Gammelager; Morten Schmidt; Henrik Nielsen; Christian Fynbo Christiansen

doi:10.1186/s12874-015-0013-2

Table 1 Diagnostic criteria used to validate shock diagnoses.

From: Positive predictive value of International Classification of Diseases, 10^th revision, diagnosis codes for cardiogenic, hypovolemic, and septic shock in the Danish National Patient Registry

Shock type	Diagnostic criteria
Shock overall	Diagnosis of shock is confirmed if sustained shock^a can be confirmed by medical chart review by at least one of the following [1,15]:^b
	1. Systolic blood pressure < 90 mmHg.
	2. Mean arterial pressure < 70 mmHg.
	3. Reduction in systolic blood pressure > 40 mmHg.
	4. Preserved systolic blood pressure achieved through inotropic/vasopressor therapy.
Cardiogenic shock	Diagnosis of cardiogenic shock is confirmed if medical chart review confirms these two criteria [4,16]:
	1. Sustained shock (as defined in shock overall) [1,15], and
	2. Two or more of the following criteria were confirmed:
	a. Cardiac index < 2.2 (L/min)/m²,
	b. pulmonary capillary wedge pressure > 18 mmHg,
	c. tachycardia (>90 beats per minute),
	d. pale, cold, clammy, or cyanotic skin,
	e. signs of oliguria, or
	f. confusion, disorientation, or loss of conscience.
Hypovolemic shock	Diagnosis of hypovolemic shock is confirmed if medical chart review confirms these two criteria:
	1. Sustained shock (as defined in shock overall) [1,15]
	2. Evidence or suspicion of shock due to (one or more of the following) [4]:
	a. Loss of red blood cell mass and plasma from hemorrhage.
	b. Loss of plasma volume alone due to extravascular fluid sequestration.
	c. Gastrointestinal, urinary, and insensible losses.
Septic shock	Diagnosis of septic shock is confirmed if medical chart review confirms these three criteria [1,15,17]:
	1. Sustained shock (as defined in shock overall) [1,15]
	2. Systemic inflammatory response syndrome (SIRS) must be diagnosed by identifying at least two or more of the following:
	a. Tachypnea: high respiratory rate) > 20 breaths per minute, or arterial blood gas, with PCO2 less than 4.3 kPa signifying hyperventilation.
	b. White blood cell count either significantly low < 4000 cells/mm³, elevated > 12000 cells/mm³, or >10 immature cells.
	c. Heart rate > 90 beats per minute.
	d. Temperature: Fever > 38.3°C (100.4°F) or hypothermia < 36.0°C (96.8°F).
	3. Sepsis and not an alternative form cause of SIRS. Sepsis requires evidence or suspicion of infection, which may include:
	a. Positive blood culture/blood culture taken as suspicious of infection,
	b. signs of pneumonia on chest x-ray, or
	c. other radiologic or laboratory evidence of infection.

^aSustained shock defined as shock > 30 minutes despite adequate fluid resuscitation.
^bBlood pressure used as a surrogate for decreased blood flow.
Abbreviation:SIRS Systemic inflammatory response syndrome.

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