Evaluation of Incident 7-Day Infection and Sepsis Hospitalizations in an Integrated Health System.

Rationale: Prehospital opportunities to predict infection and sepsis hospitalization may exist, but little is known about their incidence following common healthcare encounters.
Objectives: To evaluate the incidence and timing of infection and sepsis hospitalization within 7 days of living hospital discharge, emergency department discharge, and ambulatory visit settings.
Methods: In each setting, we identified patients in clinical strata based on the presence of infection and severity of illness. We estimated number needed to evaluate values with hypothetical predictive model operating characteristics.
Results: We identified 97,614,228 encounters, including 1,117,702 (1.1%) hospital discharges, 4,635,517 (4.7%) emergency department discharges, and 91,861,009 (94.1%) ambulatory visits between 2012 and 2017. The incidence of 7-day infection hospitalization varied from 37,140 (3.3%) following inpatient discharge to 50,315 (1.1%) following emergency department discharge and 277,034 (0.3%) following ambulatory visits. The incidence of 7-day infection hospitalization was increased for inpatient discharges with high readmission risk (10.0%), emergency department discharges with increased acute or chronic severity of illness (3.5% and 4.7%, respectively), and ambulatory visits with acute infection (0.7%). The timing of 7-day infection and sepsis hospitalizations differed across settings with an early rise following ambulatory visits, a later peak following emergency department discharges, and a delayed peak following inpatient discharge. Theoretical number needed to evaluate values varied by strata, but following hospital and emergency department discharge, were as low as 15-25. Conclusions: Incident 7-day infection and sepsis hospitalizations following encounters in routine healthcare settings were surprisingly common and may be amenable to clinical predictive models.