The death of a pediatric patient with sepsis spurred New York to mandate statewide sepsis treatment in 2013, which included a 1-hour bundle of blood cultures, broad-spectrum antibiotics, and a 20 mL/kg intravenous fluid bolus. “The New York mandate was the first of its kind for pediatric patients with sepsis,” says Dr. Evans. “No randomized clinical trials had been conducted to evaluate the association of the bundle proposed by New York State with mortality in pediatric patients.”
For a study published in JAMA, Idris Evans, MD, MSc and colleagues sought to determine the risk-adjusted association between completing the 1-hour pediatric sepsis bundle and individual bundle elements with in-hospital mortality.
Among nearly 1,200 pediatric patients with sepsis at 54 adult and pediatric specialty hospitals in New York, the completion of a 1-hour sepsis bundle was significantly associated with lower risk-adjusted, in-hospital mortality compared with not completing the bundle within 1 hour (odds ratio, 0.59).
“Completion of the bundle within 1 hour was associated with a 40% reduction in in-hospital mortality,” says Dr. Evans, “regardless of where care was provided within the hospital.”
Dr. Evans stresses that the results of this study strengthen the argument that prompt intervention can save the lives of pediatric patients with sepsis, adding that each provider or institution should investigate what processes of care are needed to ensure that a pediatric patient is treated as quickly as possible. He notes that the first step in treating pediatric sepsis is recognizing it, and that providers, therefore, should keep this infection complication in their differential when evaluating an ill pediatric patient.
PhysWeekly