A Systematic Assessment of the Surviving Sepsis Campaign’s Evidence Supporting the Care of Patients with Severe Sepsis on the Wards

Odden, Andrew; Govindan, Sushant; Sheth, Jamie; Iwashyna, Theodore J.

doi:10.1513/annalsats.201502-096le

Cited by 7 publications

(7 citation statements)

References 12 publications

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“…In addition, there are few data to support optimal treatment strategies for patients with sepsis identified on the wards, as discussed in further detail by a recent review. 24 Despite these considerations, several studies suggest that actively screening patients on the wards is associated with improved process measures and patient outcomes, as discussed further on.…”

Section: Screening For Sepsis On the Wardsmentioning

confidence: 99%

“…In fact, as outlined in a recent review, of the 122 studies used to develop these recommendations, only one prospective clinical trial, which examined the duration of empirical antibiotics, included any patients on the wards. 24 There were no patients on the wards in any trial supporting aggressive fluid resuscitation, which not only is a frequent intervention on the wards for septic patients but also is a commonly reported outcome for the efficacy of sepsis screening tools. Future research in sepsis treatment for patients on the wards is clearly needed to optimize outcomes in this population.…”

Section: Treatment Of Screen-positive Patientsmentioning

confidence: 99%

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Identifying Patients With Sepsis on the Hospital Wards

Bhattacharjee

Edelson

Churpek

2017

Chest

101

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Sepsis contributes to up to half of all deaths in hospitalized patients, and early interventions, such as appropriate antibiotics, have been shown to improve outcomes. Most research has focused on early identification and treatment of patients with sepsis in the ED and the ICU; however, many patients acquire sepsis on the general wards. The goal of this review is to discuss recent advances in the detection of sepsis in patients on the hospital wards. We discuss data highlighting the benefits and limitations of the systemic inflammatory response syndrome (SIRS) criteria for screening patients with sepsis, such as its low specificity, as well as newly described scoring systems, including the proposed role of the quick sepsis-related organ failure assessment (qSOFA) score. Challenges specific to detecting sepsis on the wards are discussed, and future directions that use big data approaches and automated alert systems are highlighted.

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Section: Screening For Sepsis On the Wardsmentioning

confidence: 99%

Section: Treatment Of Screen-positive Patientsmentioning

confidence: 99%

Identifying Patients With Sepsis on the Hospital Wards

Bhattacharjee

Edelson

Churpek

2017

Chest

101

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“…Protocols for early sepsis care, called "sepsis bundles," have been demonstrated to reduce mortality in community-onset sepsis when implemented in the emergency department (ED). 8,9 Though sepsis bundles do not have the same basis in evidence in hospital-onset sepsis, [9][10][11] the Centers for Medicare and Medicaid Services (CMS) and professional societies recommend their use in all cases of sepsis with organ dysfunction, including those of hospital-onset. [12][13][14] Overall adherence to the CMS sepsis bundle, known as SEP-1, is only 30-50%.…”

Section: Introductionmentioning

confidence: 99%

Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study

Baghdadi

Wong

Uslan³

et al. 2020

J GEN INTERN MED

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BACKGROUND: Sepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis. OBJECTIVE: To compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis. DESIGN: Retrospective cohort study using multivariable analysis of clinical data. PARTICIPANTS: A total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection. SETTING: Four university hospitals in California between 2014 and 2016. MAIN OUTCOMES AND MEASURES: The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen. KEY RESULTS: Compared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29-0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated-blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)-was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004). CONCLUSIONS: Inpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.

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“…Th17 cells are prevalent in epithelial surfaces such as the lungs, skin, and gut, where they contribute to host immune responses against bacterial, fungal, and mycobacterial pathogens largely by orchestrating the recruitment of inflammatory cells (8). Interestingly, Th17 cells have been implicated in the development of Crohn's disease, another disease characterized by noninfectious granuloma formation (8).…”

Section: Sarcoidosis and T-helper Cellsmentioning

confidence: 99%

“…receives funding from the NHLBI T32HL007287 and NIH/NIEHS P30ES007033. epigenetic effects cluster with ancestral background (8). Genomewide association studies have identified single nucleotide polymorphisms with substantial differences in allele frequency between different ancestor populations and previous studies have shown that percentage of African ancestry is associated with reduced lung function (9,10).…”

mentioning

confidence: 99%