ArticleJournal of general internal medicine2020
Adherence to the SEP-1 Sepsis Bundle in Hospital-Onset v. Community-Onset Sepsis: a Multicenter Retrospective Cohort Study.
Article in Journal of general internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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
16 citing papers in PubMed, 25 citations in OpenAlex.
- Timing matters: a machine learning-driven comparison of community and hospital-onset sepsis.BMC medical informatics and decision making · 2026Article
- Impact of the National Early Warning Score-based sepsis response system on hospital-onset sepsis in a tertiary hospital in South Korea.Acute and critical care · 2025Article
- Complex Sepsis Presentations, SEP-1 Compliance, and Outcomes.JAMA network open · 2025Article
- Bundle compliance patterns in septic shock and their association with patient outcomes: an unsupervised cluster analysis.Internal and emergency medicine · 2025Article
- SepsisJournal of medical microbiology · 2025Review
- Comparison of outcomes of community-acquired sepsis and hospital-acquired sepsis in critically ill patients: a systematic review and meta-analysis.Annals of medicine and surgery (2012) · 2025Article
- Fluid Resuscitation and Initial Management in Patients Presenting with Sepsis in the General Ward.Life (Basel, Switzerland) · 2025Article
- Article
- Hospital-Onset Sepsis Warrants Expanded Investigation and Consideration as a Unique Clinical Entity.Chest · 2024Review
- 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
- Sepsis Prediction Model for Determining Sepsis vs SIRS, qSOFA, and SOFA.JAMA network open · 2023Article
- Mortality of patients with hospital-onset sepsis in hospitals with all-day and non-all-day rapid response teams: a prospective nationwide multicenter cohort study.Critical care (London, England) · 2022Article
- Association of Unit Census with Delays in Antimicrobial Initiation among Ward Patients with Hospital-acquired Sepsis.Annals of the American Thoracic Society · 2022Article
- Should hospital-onset Adult Sepsis Event surveillance be routine… or even mandatory?Antimicrobial stewardship & healthcare epidemiology : ASHE · 2022Article
- Rapid Response System Improves Sepsis Bundle Compliances and Survival in Hospital Wards for 10 Years.Journal of clinical medicine · 2021Article
- SEP-1 Septic Shock Bundle Guidelines Not Applicable to Inpatients-Reply.JAMA internal medicine · 2020Article
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundSepsis is the leading cause of in-hospital death. The SEP-1 sepsis bundle is a protocol for early sepsis care that requires providers to diagnose and treat sepsis quickly. Limited evidence suggests that adherence to the sepsis bundle is lower in cases of hospital-onset sepsis.
objectiveTo compare sepsis bundle adherence in hospital-onset vs. community-onset sepsis.
designRetrospective cohort study using multivariable analysis of clinical data.
participantsA total of 4658 inpatients age 18 or older were identified by diagnosis codes consistent with sepsis or disseminated infection.
settingFour university hospitals in California between 2014 and 2016. MAIN OUTCOMES AND MEASURES: The primary outcome was adherence to key components of the sepsis bundle defined by the Centers for Medicare and Medicaid Services in their core measure, SEP-1. Covariates included clinical characteristics related to the patient, infection, and pathogen. KEY
resultsCompared with community-onset, cases of hospital-onset sepsis were less likely to receive SEP-1 adherent care (relative risk 0.33, 95% confidence interval 0.29-0.38, p < 0.001). With the exception of vasopressors (RR 1.11, p = 0.002), each component of SEP-1 evaluated-blood cultures (RR 0.76, p < 0.001), serum lactate (RR 0.51, p < 0001), broad-spectrum antibiotics (RR 0.62, p < 0.001), intravenous fluids (0.47, p < 0.001), and follow-up lactate (RR 0.71, p < 0.001)-was less likely to be performed within the recommended time frame in hospital-onset sepsis. Within the hospital, cases of hospital-onset sepsis arising on the ward were less likely to receive SEP-1-adherent care than were cases arising in the intensive care unit (RR 0.68, p = 0.004).
conclusionsInpatients with hospital-onset sepsis receive different management than individuals with community-onset sepsis. It remains to be determined whether system-level factors, provider-level factors, or factors related to measurement explain the observed variation in care or whether variation in care affects outcomes.
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