Evans IVR, et al. - Researchers investigated if following statewide mandated care for pediatric sepsis, the prompt completion of a 1-hour bundle was associated with lower risk-adjusted in-hospital mortality. In this statewide cohort study conducted from April 1, 2014, to December 31, 2016, in Emergency Departments, inpatient units, and intensive care units across New York State, the completion of a 1-hour sepsis bundle that included blood cultures, broad spectrum antibiotics, and a 20-mL/kg fluid bolus was markedly correlated with lower risk-adjusted in-hospital mortality compared with not completing the bundle within 1 hour. Hence suggesting the potential of timely completion of a 1-hour bundle of care for improving outcomes in pediatric sepsis.

Methods

• In this statewide cohort study, researchers included a total of 1179 patients aged 18 years and younger with sepsis and septic shock reported to the New York State Department of Health who had a sepsis protocol initiated.
• Exposures included completion of a 1-hour sepsis bundle within 1 hour vs not completing the 1-hour sepsis bundle within 1 hour.
• Risk-adjusted in-hospital mortality was assessed as the main outcome .

Results

• At 54 hospitals, researchers identified 1179 patients who presented with sepsis (mean [SD] age, 7.2 [6.2] years; male, 54.2%; previously healthy, 44.5%; diagnosed as having shock, 68.8%).
• Death of 139/1179 (11.8%) patients was reported.
• In this work, 294 patients (24.9%) completed the entire sepsis bundle in 1 hour.
• Within 1 hour, 798 patients (67.7%) received antibiotics, blood cultures were obtained in 740 patients (62.8%), and the fluid bolus was completed in 548 patients (46.5%).
• Observations suggested an association of completion of the entire bundle within 1 hour with reduced risk-adjusted odds of in-hospital mortality (odds ratio [OR], 0.59 [95% CI, 0.38 to 0.93], P=.02; predicted risk difference [RD], 4.0% [95% CI, 0.9% to 7.0%]).
• However, no significant association of completion of each individual bundle element within 1 hour with lower risk-adjusted mortality was observed (blood culture: OR, 0.73 [95% CI, 0.51 to 1.06], P=.10; RD, 2.6% [95% CI, -0.5% to 5.7%]; antibiotics: OR, 0.78 [95% CI, 0.55 to 1.12], P=.18; RD, 2.1% [95% CI, -1.1% to 5.2%], and fluid bolus: OR, 0.88 [95% CI, 0.56 to 1.37], P=.56; RD, 1.1% [95% CI, -2.6% to 4.8%]).