New York's sepsis treatment mandate linked to lower in-hospital mortality

When hospital staff completes a series of clinical sepsis treatments and tests within an hour of its detection, hospitalized pediatric patients' chances of survival significantly rise, a study published in JAMA found.

The study, led by researchers at the University of Pittsburgh School of Medicine, looked at the outcomes of 1,179 children with sepsis at 54 New York hospitals. About 44 percent of the children were healthy before developing sepsis, and 139 patients died.

Completion of the sepsis protocol within one hour decreased the odds of death by 40 percent. When only parts of the protocol were completed within an hour — for example, giving fluids but not testing for infection or giving antibiotics — the patients did not fare better. The finding held only if the entire protocol was completed in an hour.

The study findings support a New York state mandate implemented in 2013 called Rory's Regulations, named after 12-year-old patient Rory Staunton, who died from undiagnosed sepsis in 2012.

Rory's Regulations require every New York hospital to follow evidence-based clinical practice protocols for identifying and managing sepsis in a timely matter.

"It's clear that completing the entire sepsis protocol within an hour is associated with lower mortality," said lead author Idris V.R. Evans, MD, in a news release. "But the mechanism of benefit still requires more study."

Testing the sepsis protocol in future randomized clinical trials will present difficulties, the researchers said. It would require some protocol elements being left off for certain septic children (but not others) in a random way, a design not currently aligned with the standard of care.

But if more states adopt regulations like New York's, while mandating data reporting, future work could expand on these results, the researchers said.

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