32: Improving Pediatric Sepsis Outcomes for All Children Together (IPSO FACTO): Interim Results

Paul, Raina; Brilli, Richard J.; Macias, Charles G.; Gruhler, Heidi; Riggs, Ruth; Richardson, Troy

doi:10.1097/01.ccm.0000726156.07482.0f

Cited by 5 publications

(3 citation statements)

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“…Patients were included in the IPSO database if they meet previously published IPSO sepsis definitions, which are based on sepsis-specific recognition tools and intention-to-treat sepsis interventions (eAppendix in Supplement 1). 25,26 IPSO critical patients with sepsis are a subset of the IPSO sepsis cohort (eAppendix in Supplement 1). 25 The IPSO database includes an estimate of the time of sepsis recognition, known as functional time zero (FTZ), which is the earliest time of a sepsis screen, huddle, order set use, first intravenous (IV) fluid, or antibiotic administration (eAppendix in Supplement 1).…”

Section: Design and Data Sourcementioning

confidence: 99%

“…25 The IPSO database includes an estimate of the time of sepsis recognition, known as functional time zero (FTZ), which is the earliest time of a sepsis screen, huddle, order set use, first intravenous (IV) fluid, or antibiotic administration (eAppendix in Supplement 1). 26 For this study, we abstracted data from the IPSO database, including demographic, clinical, processes of care, and outcome variables.…”

Section: Design and Data Sourcementioning

confidence: 99%

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Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis

Lane,

Richardson,

Scott

et al. 2024

JAMA Netw Open

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ImportancePediatric consensus guidelines recommend antibiotic administration within 1 hour for septic shock and within 3 hours for sepsis without shock. Limited studies exist identifying a specific time past which delays in antibiotic administration are associated with worse outcomes.ObjectiveTo determine a time point for antibiotic administration that is associated with increased risk of mortality among pediatric patients with sepsis.Design, Setting, and ParticipantsThis retrospective cohort study used data from 51 US children’s hospitals in the Improving Pediatric Sepsis Outcomes collaborative. Participants included patients aged 29 days to less than 18 years with sepsis recognized within 1 hour of emergency department arrival, from January 1, 2017, through December 31, 2021. Piecewise regression was used to identify the inflection point for sepsis-attributable 3-day mortality, and logistic regression was used to evaluate odds of sepsis-attributable mortality after adjustment for potential confounders. Data analysis was performed from March 2022 to February 2024.ExposureThe number of minutes from emergency department arrival to antibiotic administration.Main Outcomes and MeasuresThe primary outcome was sepsis-attributable 3-day mortality. Sepsis-attributable 30-day mortality was a secondary outcome.ResultsA total of 19 515 cases (median [IQR] age, 6 [2-12] years) were included. The median (IQR) time to antibiotic administration was 69 (47-116) minutes. The estimated time to antibiotic administration at which 3-day sepsis-attributable mortality increased was 330 minutes. Patients who received an antibiotic in less than 330 minutes (19 164 patients) had sepsis-attributable 3-day mortality of 0.5% (93 patients) and 30-day mortality of 0.9% (163 patients). Patients who received antibiotics at 330 minutes or later (351 patients) had 3-day sepsis-attributable mortality of 1.2% (4 patients), 30-day mortality of 2.0% (7 patients), and increased adjusted odds of mortality at both 3 days (odds ratio, 3.44; 95% CI, 1.20-9.93; P = .02) and 30 days (odds ratio, 3.63; 95% CI, 1.59-8.30; P = .002) compared with those who received antibiotics within 330 minutes.Conclusions and RelevanceIn this cohort of pediatric patients with sepsis, 3-day and 30-day sepsis-attributable mortality increased with delays in antibiotic administration 330 minutes or longer from emergency department arrival. These findings are consistent with the literature demonstrating increased pediatric sepsis mortality associated with antibiotic administration delay. To guide the balance of appropriate resource allocation with time for adequate diagnostic evaluation, further research is needed into whether there are subpopulations, such as those with shock or bacteremia, that may benefit from earlier antibiotics.

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Section: Design and Data Sourcementioning

confidence: 99%

Section: Design and Data Sourcementioning

confidence: 99%

Delays to Antibiotics in the Emergency Department and Risk of Mortality in Children With Sepsis

Lane,

Richardson,

Scott

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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“…The study 5 is commendable for its sample size compared with previous work, 3,4 capturing a range of US hospitals that participate in the largest pediatric sepsis quality improvement effort globally. 6 The IPSO collaborative focuses on enhancing pediatric sepsis outcomes by promoting earlier recognition and treatment of children, with rigorous quality metrics based on established criteria prospectively captured in a well-described database. Unlike the previous International Pediatric Sepsis Consensus Conference criteria, which relied on systemic inflammatory response syndrome markers, and the Phoenix criteria, 7 based on administration of antibiotics and/or fluids, and 449 were excluded because the antibiotic was given more than 7 hours after presentation.…”

mentioning

confidence: 99%