Pediatric Outcomes After Regulatory Mandates for Sepsis Care

Affiliations

PMID: 32605994
PMCID: PMC7329251 (available on 2021-07-01)
DOI: 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.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: Dr Angus received personal fees from Ferring Pharmaceutical Inc, Bristol-Myers Squibb, Bayer AG, GenMark Diagnostics, Sobi Inc, Beckman Coulter Inc, and ALung Technologies Inc and has patents pending from Selepressin and Proteomic; the other authors have indicated they have no potential conflicts of interest to disclose.

Comment in

The Legacy of Pediatric Sepsis State Legislation.
Scott HF, Balamuth F, Alpern ER.Pediatrics. 2020 Jul;146(1):e20201525. doi: 10.1542/peds.2020-1525.PMID: 32605993 No abstract available.