Methodologies in health services research for critical careEpidemiology and economic evaluation of severe sepsis in France: age, severity, infection site, and place of acquisition (community, hospital, or intensive care unit) as determinants of workload and cost✯
Section snippets
Objectives
Severe sepsis, defined as sepsis with acute organ dysfunction, causes systemic inflammation and is associated with high morbidity and mortality rates. In the United States, approximately 750 000 cases of severe sepsis occur each year, with a mortality rate ranging from 30% to 50% despite advances in critical care management [1], [2], [3], [4].
Organ dysfunctions contribute a large part of the mortality and morbidity related to severe sepsis and require time-consuming high-cost treatments.
Study design
This retrospective study was conducted using data collected prospectively from April 1997 (2 ICUs) or April 1998 (4 ICUs) to December 2000 in France (OUTCOMEREA database). All adults (age, >16 years) hospitalized for more than 48 hours were included. There were 2 surgical ICUs (13 beds), 2 medical ICUs (26 beds), and 2 general ICUs (26 beds). Overall, 70% of patients were admitted for medical reasons. All 6 ICUs were located in Paris (n = 4) or near Paris (n = 2). Four ICUs were in teaching
Acknowledgments
We thank Philippe Pinton, MD (Lilly, France), for his helpful remarks regarding the study design and Antoinette Wolfe, MD, for her help in preparing this manuscript.
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OUTCOMEREA is supported by nonexclusive educational grants from Aventis Pharma France, Wyeth, and the Center National de la Recherche Scientifique (Paris). The pharmaceutical company Eli Lilly supported the data mining and statistical analysis of the data on patients with severe sepsis included in the OUTCOMEREA data warehouse. They gave general advice on the study design but had no role in collecting, analyzing, or interpreting the data.