Completion of a care bundle for pediatric patients within 1 hour of sepsis recognition, including blood cultures, broad-spectrum antibiotics, and a 20-mL/kg intravenous fluid bolus, was associated with lower in-hospital mortality among children with sepsis and septic shock, according to new findings published in JAMA.
After the death of a pediatric patient with sepsis in 2013, New York State mandated that all hospitals provide a “1-hour care bundle” to any pediatric patient presenting with signs of sepsis. However, it has remained unclear whether this mandate has improved outcomes. Using a cohort of 1179 pediatric patients treated for sepsis at 54 hospitals, the investigators of this study compared completion of the 1-hour bundle with nonadherence to this protocol.
The mandate was completed in 294 patients (24.9%). Within the 1 hour window, 798 (67.7%) patients received antibiotics, blood cultures were drawn in 740 patients (62.8%), and fluid bolus was administered to 548 patients (46.5%). The completion of the entire bundle within 1 hour was associated with lower risk-adjusted odds of in-hospital mortality (odds ratio [OR], 0.59 [95% CI, 0.38-0.93; P =.02]; predicted risk difference [RD], 4.0% [95% CI, 0.9%-7.0%]), but each individual bundle element alone did not significantly affect mortality (blood culture: OR, 0.73 [95% CI, 0.51-1.06; P =.10]; RD, 2.6% [95% CI, −0.5% to 5.7%]; antibiotics: OR, 0.78 [95% CI, 0.55-1.12; P =.18]; RD, 2.1% [95% CI, −1.1% to 5.2%]; or fluid bolus: OR, 0.88 [95% CI, 0.56-1.37], P =.56; RD, 1.1% [95% CI, −2.6% to 4.8%]).
The investigators note that the true effect of bundle completion “may be smaller than measured in this study and could be further evaluated in designs that incorporate data from before and after the implementation of the mandate.”
Evans IVR, Phillips GS, et al. Association between the New York sepsis care mandate and in-hospital mortality for pediatric sepsis. JAMA. 2018;320(4):358-367.