Evidence map›Paper›PMID 25946168›Full record

SynthesisPloS one2015

Effect of performance improvement programs on compliance with sepsis bundles and mortality: a systematic review and meta-analysis of observational studies.

Elisa Damiani, Abele Donati, Giulia Serafini, Laura Rinaldi, Erica Adrario, Paolo Pelaia, Stefano Busani, Massimo Girardis

3 registry-linked trialsAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in PloS one, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 3 registered trials, which are not on this map. Cited by 120 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
120citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04143035 unknown statusnot on this mapstarted 2019, after this paper: background citation

Hemodynamic Resuscitation and Monitoring in Early Sepsis

TypeobservationalSponsorTata Memorial CentreRan2019 to 2023Enrolled500ConditionsSeptic ShockArmsNo Intervention
NCT05094154 phase4completednot on this mapstarted 2021, after this paper: background citation

Effect of Antibiotic Choice On ReNal Outcomes (ACORN)

TypeinterventionalSponsorVanderbilt University Medical CenterRan2021 to 2022Enrolled2,634ConditionsSepsis, AKI, NeurotoxicityArmsanti-pseudomonal cephalosporin, anti-pseudomonal penicillin
NCT06657625 unknown statusnot on this mapstarted 2024, after this paper: background citation

Impact of the Introduction of a Performance Improvement Program on the Initial Management of Sepsis and Septic Shock in Adults in the Emergency Department: a Before-and-after Study

TypeobservationalSponsorUniversity Hospital, BrestRan2024 to 2026Enrolled600ConditionsSepsis, Septic Shock, Critical Illness, Emergency MedicineArmsSepsis Performance Improvement Program
3 · Its place in the literature

Who cites it

120 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
  2. [S3 guideline on sepsis-prevention, diagnosis, therapy, and follow-up care-update 2025].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2025
    Guideline
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. [S3 Guideline Sepsis-prevention, diagnosis, therapy, and aftercare : Long version].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2020
    Guideline
  9. Pooled it
  10. Guideline
  11. Trial
  12. Trial
  13. Trial
  14. Trial
  15. Review
  16. [Sepsis 2026: diagnosis and treatment].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2026
    Review
  17. Article
  18. Article
  19. Article
  20. Article

60 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors.

Elisa DamianiAnesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Abele DonatiAnesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Giulia SerafiniDepartment of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Laura RinaldiDepartment of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Erica AdrarioAnesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Paolo PelaiaAnesthesia and Intensive Care Unit, Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, Via Tronto 10, 60126 Torrette di Ancona, Italy.
Stefano BusaniDepartment of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.
Massimo GirardisDepartment of Anesthesiology and Intensive Care, Modena University Hospital, L.go del Pozzo 71, 41100 Modena, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSeveral reports suggest that implementation of the Surviving Sepsis Campaign (SSC) guidelines is associated with mortality reduction in sepsis. However, adherence to the guideline-based resuscitation and management sepsis bundles is still poor.

objectiveTo perform a systematic review of studies evaluating the impact of performance improvement programs on compliance with Surviving Sepsis Campaign (SSC) guideline-based bundles and/or mortality. DATA SOURCES: Medline (PubMed), Scopus and Intercollegiate Studies Institute Web of Knowledge databases from 2004 (first publication of the SSC guidelines) to October 2014. STUDY SELECTION: Studies on adult patients with sepsis, severe sepsis or septic shock that evaluated changes in compliance to individual/combined bundle targets and/or mortality following the implementation of performance improvement programs. Interventions may consist of educational programs, process changes or both. DATA EXTRACTION: Data from the included studies were extracted independently by two authors. Unadjusted binary data were collected in order to calculate odds ratios (OR) for compliance to individual/combined bundle targets. Adjusted (if available) or unadjusted data of mortality were collected. Random-effects models were used for the data synthesis.

resultsFifty observational studies were selected. Despite high inconsistency across studies, performance improvement programs were associated with increased compliance with the complete 6-hour bundle (OR = 4.12 [95% confidence interval 2.95-5.76], I(2) = 87.72%, k = 25, N = 50,081) and the complete 24-hour bundle (OR = 2.57 [1.74-3.77], I(2) = 85.22%, k = 11, N = 45,846) and with a reduction in mortality (OR = 0.66 [0.61-0.72], I(2) = 87.93%, k = 48, N = 434,447). Funnel plots showed asymmetry.

conclusionsPerformance improvement programs are associated with increased adherence to resuscitation and management sepsis bundles and with reduced mortality in patients with sepsis, severe sepsis or septic shock.

Indexed as

Guideline AdherenceOutcome and Process Assessment, Health CareAdultHospital MortalityHumansIntensive Care UnitsResuscitationRisk AssessmentSepsisShock, Septic

Identifiers

PMID25946168
PMCPMC4422717

What OpenQuestion holds

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LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.