Completion of a sepsis bundle within one hour may lower in-hospital mortality for pediatric patients with sepsis or septic shock

Resident Focus - Volume 13, Issue 5

Reference: JAMA 2018 Jul 24;320(4):358-367

Level 2 [mid-level] evidence


In 2013 the death of a pediatric patient with sepsis triggered New York State to require that all hospitals must provide pediatric patients with a sepsis bundle within one hour after diagnosis. The bundle includes three elements: blood cultures prior to administration of antibiotics, broad-spectrum antibiotics, and a 20mL/kg fluid bolus. Is completion of this bundle within one hour associated with lower in-hospital mortality for pediatric patients with sepsis or septic shock?

A retrospective cohort study assessed the outcomes of this intervention using data from the New York State Department of Health database. 1,179 patients aged 18 years or younger with septic shock or sepsis who were seen in emergency departments, wards and intensive care units in 54 acute care hospitals between April 2014 and December 2016, were evaluated.

7.5% of patients who received the bundle within one hour died compared to 13.2% of those who did not. Completion of the three elements of the pediatric sepsis bundle within one hour was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.59, 95% confidence interval 0.38- 0.93). On the other hand, completion of each of the three individual elements of the pediatric sepsis bundle was not associated with significantly lower mortality. Patients who were previously healthy or were evaluated in the emergency department were significantly more likely to have the sepsis bundle initiated and completed within one hour, whereas patients who were transferred into the hospital were less likely to have the sepsis bundle completed within one hour.

This study suggests completion of the entire sepsis bundle (but not the bundle’s individual elements) within one hour may decrease in-hospital mortality in pediatric patients with sepsis or septic shock. In future analyses, it would be beneficial to measure and account for confounders such as severity of illness, sensitivity of antimicrobial therapy, presence of acute kidney injury, and concomitant complications.

For more information, see the Sepsis in children in Dynamed Plus. DynaMed users, see the Sepsis in children topic in Dynamed Classic.

ROLA AKACHE, MD is a first-year resident at the Memorial Health University Medical Center Family Medicine Residency program. She is originally from Miami, Florida. She completed her undergraduate training at Florida International University and then matriculated to Edward Via College of Osteopathic Medicine Carolinas Campus where she completed her medical degree before matching at MHUMC. She is interested in full spectrum family medicine.

Faculty contributions by Marvin H. Sineath, Jr., MD.


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