Pediatric Outcomes After Regulatory Mandates for Sepsis Care
- 30 June 2020
- journal article
- research article
- Published by American Academy of Pediatrics (AAP) in Pediatrics
- Vol. 146 (1), e20193353
- https://doi.org/10.1542/peds.2019-3353
Abstract
BACKGROUND: In 2013, New York introduced regulations mandating that hospitals develop pediatric-specific protocols for sepsis recognition and treatment. METHODS: We used hospital discharge data from 2011 to 2015 to compare changes in pediatric sepsis outcomes in New York and 4 control states: Florida, Massachusetts, Maryland, and New Jersey. We examined the effect of the New York regulations on 30-day in-hospital mortality using a comparative interrupted time-series approach, controlling for patient and hospital characteristics and preregulation temporal trends. RESULTS: We studied 9436 children admitted to 237 hospitals. Unadjusted pediatric sepsis mortality decreased in both New York (14.0% to 11.5%) and control states (14.4% to 11.2%). In the primary analysis, there was no significant effect of the regulations on mortality trends (differential quarterly change in mortality in New York compared with control states: −0.96%; 95% confidence interval [CI]: −1.95% to 0.02%; P = .06). However, in a prespecified sensitivity analysis excluding metropolitan New York hospitals that participated in earlier sepsis quality improvement, the regulations were associated with improved mortality trends (differential change: −2.08%; 95% CI: −3.79% to −0.37%; P = .02). The regulations were also associated with improved mortality trends in several prespecified subgroups, including previously healthy children (differential change: −1.36%; 95% CI: −2.62% to −0.09%; P = .04) and children not admitted through the emergency department (differential change: −2.42%; 95% CI: −4.24% to −0.61%; P = .01). CONCLUSIONS: Implementation of statewide sepsis regulations was generally associated with improved mortality trends in New York State, particularly in prespecified subpopulations of patients, suggesting that the regulations were successful in affecting sepsis outcomes.Keywords
This publication has 33 references indexed in Scilit:
- Emergency Department Pediatric Readiness and Mortality in Critically Ill ChildrenPediatrics, 2019
- Access to High Pediatric-Readiness Emergency Care in the United StatesThe Journal of Pediatrics, 2018
- Comparison of Transferred Versus Nontransferred Pediatric Patients Admitted for SepsisAir Medical Journal, 2016
- Pediatric Severe Sepsis in U.S. Children’s Hospitals*Pediatric Critical Care Medicine, 2014
- Sepsis MandatesJAMA, 2014
- Regulatory Mandates for Sepsis Care — Reasons for CautionNew England Journal of Medicine, 2014
- Use of Interrupted Time Series Analysis in Evaluating Health Care Quality ImprovementsAcademic Pediatrics, 2013
- Trends in the Epidemiology of Pediatric Severe Sepsis*Pediatric Critical Care Medicine, 2013
- The Value of Statistical Analysis Plans in Observational ResearchJAMA, 2012
- Pediatric Deaths Attributable to Complex Chronic Conditions: A Population-Based Study of Washington State, 1980–1997Pediatrics, 2000