Septicemia Statistics and the Need for Death Certificate Reform

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Note: “Sepsis” and “Septicemia” are used interchangeably, according to the articles they are referenced in below.

Death certificates are the primary source of important vital statistics in our country – yet too many certificates fail to tell the whole story.

Over 34,000 Americans are dying from septicemia each year, a toxic bloodstream infection that is often caught in hospitals, yet many hospitals are keeping that a secret. Frequently when patients develop septicemia (often used interchangeably with “sepsis”), this results in other health problems that hospitals can list as the cause of death. Inaccurate or dishonest death certificates detract from a hospital’s need to reduce their infection rates and ultimately keep vital information from patients and family members.

Septicemia, also known as blood poisoning, is a condition caused by a serious infection that gets into the bloodstream from bacterial contamination. Symptoms include chills, high fever, dropping blood pressure, racing heart beat, confusion, weakness, pale face, sweating, and dropping oxygen levels. To put it mildly, you are very, very sick and need emergency medical attention.

According to a 2003 New England Journal of Medicine study, sepsis is often lethal, killing 20 to 50 percent of severely affected patients. In 1996, it was declared the 12th leading cause of death, killing 21,295 people. Since 1998 septicemia has surpassed suicide as the 10th leading cause of death in America. And the numbers are getting worse. In 2007 (the latest available data) septicemia killed 34,851 people, with the elderly dying at the highest rates.

The following news sent to me from a fellow patient safety advocate shocked me: A recent large scale study shows that sepsis and pneumonia caused by hospital-acquired infections kills 48,000 people per year and costs 1.8 billion dollars to treat.

The operative words are “caused by hospital-acquired infections (HAIs).” We’ve known for a long time that HAIs can be deadly. Estimates on the number of deaths associated with HAIs are 99,000 per year. But because so many HAI-related deaths are clumped into general categories on death certificates, CDC death rate statistics (which are gathered from death certificate information) are at best conservative estimates that don’t reveal much about the true nature of these deadly septicemia infections. In far too many cases, we have no idea what bacteria caused the septicemia (MRSA, Klabsiella, etc.) nor where it originated (surgical site, central line, urinary tract infection, etc.). This is also true for many deadly medical errors. The National Academy for State Health Policy wrote in 2001:

Medical errors on death certificates are most likely under-reported, as they are not required to be reported. Certain types of medical errors may not be reported as such; for example medication errors may be reported under the category for poisonings. Death certificate data do not always correctly identify the cause of death…

When doctors are filling out the death certificate, they can and often list the cause of death as “kidney failure,” “respiratory failure,” or even “cardiac arrest,” when, in fact, it was the septicemia that caused the organ failure or cardiac arrest to happen…and it was the hospital infection that caused the septicemia. This would be like a car accident victim’s cause of death listed as “multiple trauma” with no mention of the auto accident at all. Think of the implications this would have for the CDC and The National Highway and Transportation Agency who depend on accurate data for research and prevention of motor vehicle deaths.

Hospital-acquired infections are killing lots of people; lots more than we know of because they are not all being counted. Some of these deaths are reflected in septicemia mortality statistics. But many—too many people’s deaths—are not being counted at all. They are invisible.

Death certificate reform is long overdue. All hospital infection-related deaths should be documented in death certificates. There is simply too much at stake for families who deserve to know the true cause of death and have accurate family medical records, for public health policy experts who depend on accurate vital statistics for funding, research and mortality prevention, and for state public health departments who provide oversight for hospital safety. But most of all, we need death certificate reform because it’s the right thing to do for patients and family members who have died from preventable hospital infections.