ArticleCritical care medicine2018
Compliance With the National SEP-1 Quality Measure and Association With Sepsis Outcomes: A Multicenter Retrospective Cohort Study.
Article in Critical care medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers, 4 of them syntheses that pooled it.
What it found
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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.
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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.
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Who cites it
59 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The Effect of Severe Sepsis and Septic Shock Management Bundle (SEP-1) Compliance and Implementation on Mortality Among Patients With Sepsis : A Systematic Review.Annals of internal medicine · 2025Pooled it
- Timing of antibiotic initiation in sepsis and neutropenic fever.Frontiers in medicine · 2025Pooled it
- Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children.Intensive care medicine · 2020Guideline
- Antibiotic- and Fluid-Focused Bundles Potentially Improve Sepsis Management, but High-Quality Evidence Is Lacking for the Specificity Required in the Centers for Medicare and Medicaid Service's Sepsis Bundle (SEP-1).Critical care medicine · 2019Pooled it
- Factors Associated With Mortality Among Septic Hospital Ward Patients.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- Time to Antibiotics and Mortality in Immunocompromised Versus Non-immunocompromised Patients With Suspected Sepsis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Artificial intelligence in the emergency department-- applications, perceptions and limitations: a narrative review.World journal of emergency medicine · 2026Review
- The Global Impact of Sepsis: Epidemiology, Recognition, Management, and Health System Challenges.Epidemiologia (Basel, Switzerland) · 2026Review
- Are SEP-1 and blood culture stewardship at odds? Retrospective review of SEP-1 failures pre- and during a blood culture bottle shortage.Infection control and hospital epidemiology · 2026Article
- Syndromic Analysis of Sepsis Cohorts Using Large Language Models.JAMA network open · 2025Article
- A systematic review and meta-analysis of noradrenaline compared to adrenaline in the management of septic shock.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Review
- The association of sepsis bundle compliance with mortality in patients with ICU-acquired sepsis: a cohort study.BMC infectious diseases · 2025Article
- Complex Sepsis Presentations, SEP-1 Compliance, and Outcomes.JAMA network open · 2025Article
- The role of artificial intelligence in sepsis in the Emergency Department: a narrative review.Annals of translational medicine · 2025Review
- Extremely early initiation of vasopressors might not decrease short-term mortality for adults with septic shock: a systematic review and meta-analysis.Annals of intensive care · 2025Article
- Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity.Chest · 2024Review
- In-Hospital vs 30-Day Sepsis Mortality at US Safety-Net and Non-Safety-Net Hospitals.JAMA network open · 2024Article
- Improving Sepsis Outcomes in the Era of Pay-for-Performance and Electronic Quality Measures: A Joint IDSA/ACEP/PIDS/SHEA/SHM/SIDP Position Paper.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Impact of time to treatment in first occurrence, non-severeAntimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Risk of Misleading Conclusions in Observational Studies of Time-to-Antibiotics and Mortality in Suspected Sepsis.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2023Article
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Authors and funding
19 authors.
Funding
Abstract
objectivesMany septic patients receive care that fails the Centers for Medicare and Medicaid Services' SEP-1 measure, but it is unclear whether this reflects meaningful lapses in care, differences in clinical characteristics, or excessive rigidity of the "all-or-nothing" measure. We compared outcomes in cases that passed versus failed SEP-1 during the first 2 years after the measure was implemented.
designRetrospective cohort study.
settingSeven U.S. hospitals. PATIENTS: Adult patients included in SEP-1 reporting between October 2015 and September 2017.
interventionsNone. MEASUREMENTS AND MAIN
resultsOf 851 sepsis cases in the cohort, 281 (33%) passed SEP-1 and 570 (67%) failed. SEP-1 failures had higher rates of septic shock (20% vs 9%; p < 0.001), hospital-onset sepsis (11% vs 4%; p = 0.001), and vague presenting symptoms (46% vs 30%; p < 0.001). The most common reasons for failure were omission of 3- and 6-hour lactate measurements (228/570 failures, 40%). Only 86 of 570 failures (15.1%) had greater than 3-hour delays until broad-spectrum antibiotics. Cases that failed SEP-1 had higher in-hospital mortality rates (18.4% vs 11.0%; odds ratio, 1.82; 95% CI, 1.19-2.80; p = 0.006), but this association was no longer significant after adjusting for differences in clinical characteristics and severity of illness (adjusted odds ratio, 1.36; 95% CI, 0.85-2.18; p = 0.205). Delays of greater than 3 hours until antibiotics were significantly associated with death (adjusted odds ratio, 1.94; 95% CI, 1.04-3.62; p = 0.038), whereas failing SEP-1 for any other reason was not (adjusted odds ratio, 1.10; 95% CI, 0.70-1.72; p = 0.674).
conclusionsCrude mortality rates were higher in sepsis cases that failed versus passed SEP-1, but there was no difference after adjusting for clinical characteristics and severity of illness. Delays in antibiotic administration were associated with higher mortality but only accounted for a small fraction of SEP-1 failures. SEP-1 may not clearly differentiate between high- and low-quality care, and detailed risk adjustment is necessary to properly interpret associations between SEP-1 compliance and mortality.
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