Evans IVR, Phillips GS, Alpern ER, et al. Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis. JAMA. 2018;320:358–367. doi:10.1001/jama.2018.9071
New York State mandated a sepsis bundle of care (intravenous fluids, blood culture, and intravenous antibiotics) for pediatric patients in 2013. This study assessed completion of the bundle and clinical outcomes at 59 hospitals in New York from 4/1/14-12/31/16. One-quarter of patients with sepsis or septic shock (1179 cases in total) across multiple care settings (ED, inpatient, ICU) completed the bundle within 1 hour; these patients had lower risk-adjusted mortality than their peers (8.7% vs 12.7%, p=.02; odds of mortality with completed bundle=0.59; 95% confidence interval 0.38-0.93).
Under the New York State mandate, hospitals were required to institute a protocol for identification and care of patients at risk for sepsis. Although the protocols could vary, all were required to include goals of blood culture obtained prior to antibiotic administration, 20mL/kg intravenous fluids, and broad-spectrum antibiotics within 1 hour of protocol initiation. The analyses of health outcomes were adjusted for patient age and race, site of initiation of the bundle, existing health conditions, and illness severity. Interestingly, individual completion of the bundle components (rather than completion of the full bundle) did not improve survival. In addition to findings related to completion of the bundle at 1 hour, completion within 3 hours was also associated with lower mortality (adjusted OR=0.64 [95% CI 0.42-0.96]). Completion of the bundle was also associated with shorter length of stay among survivors. Hospitals significantly varied in their ability to complete the bundle within 1 hour (7.3% to 46.1%). Hospitals with higher rates of completed sepsis bundles saw greater numbers of pediatric patients and had pediatric intensive care units with pediatric subspecialty care available.