Time to Treatment and Mortality during Mandated Emergency Care for Sepsis - NEJM

Jaz-Michael King

http://www.nejm.org/doi/full/10.1056/NEJMoa1703058#t=article

More than 1.5 million cases of sepsis occur in the United States annually, and many patients with sepsis present to the emergency department. International clinical practice guidelines and the Centers for Medicare and Medicaid Services (CMS) recommend the prompt identification of sepsis and treatment with broad-spectrum antibiotic agents and intravenous fluids. These recommendations are supported by preclinical and observational studies suggesting that early treatment with antibiotics and intravenous fluids could reduce the number of avoidable deaths.

Yet, considerable controversy exists about how rapidly sepsis must be treated. Some clinicians question the potential benefit of rapid treatment, citing the absence of data from randomized trials, the potential for adverse effects, and the challenging implementation of these efforts in environments where staff are often overworked. Using data from New York, where hospitals are required to implement protocols and report on the treatment of sepsis, we examined the association between the timing of treatment and risk-adjusted mortality.