Evidence map›Paper›PMID 40462110›Full record

ArticleCritical care (London, England)2025

Impact of the Japanese clinical practice guidelines for management of sepsis and septic shock (J-SSCG) 2020 on real-world adherence and interhospital variation: a nationwide inpatient database study.

Hiroyuki Ohbe, Kazuma Yamakawa, Daisuke Kudo, Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga, Tomoaki Yatabe, Moritoki Egi, Hiroshi Ogura and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
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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

12 authors.

Hiroyuki OhbeDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. hohbey@gmail.com.
Kazuma YamakawaDepartment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-machi, Takatsuki, 569-8686, Osaka, Japan.
Daisuke KudoDepartment of Emergency and Critical Care Medicine, Tohoku University Hospital, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
Shotaro AsoDepartment of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Hiroki MatsuiDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Kiyohide FushimiDepartment of Health Policy and Informatics, Institute of Science Tokyo Graduate School, 2-12-1 Ookayama, Meguro-ku, Tokyo, 152-8550, Japan.
Hideo YasunagaDepartment of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Tomoaki YatabeEmergency Department, Nishichita General Hospital, 3-1-1 Nakanoike, Tokai-shi, 477-8522, Aichi, Japan.
Moritoki EgiDepartment of Anesthesia and Intensive Care, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
Hiroshi OguraDepartment of Clinical Laboratory, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka-shi, 558-8558, Osaka, Japan.
Osamu NishidaDepartment of Anesthesiology and Critical Care Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Aichi, Japan.
Shigeki KushimotoDivision of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Miyagi, Japan.

Funding

Ministry of Health, Labour and Welfare 23AA2003
6 · The paper itself

Abstract

backgroundThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock (J-SSCG) 2020 aimed to standardize sepsis care in Japan. However, the extent of their impact on clinical practice remains uncertain.

methodsWe conducted a nationwide retrospective cohort study using the Japanese Diagnosis Procedure Combination database between April 2018 and December 2021. Of the 118 clinical questions (CQs) in the J-SSCG 2020, we identified 26 recommendations to which adherence could be evaluated using patient-level data. We evaluated adherence trends before and after the guideline's publication using interrupted time series analysis and quantified hospital-level variation using intraclass correlation coefficients.

resultsA total of 213,099 patients with sepsis from 791 hospitals were included. Adherence rates varied widely across CQs (range: 0.5-98.7%). Recommendations "against" interventions generally showed high adherence, whereas those "for" interventions exhibited lower and more variable adherence. After guideline publication, adherence increased by < 3% points for most CQs. Interrupted time series analysis demonstrated no abrupt or substantial changes, and statistically significant trends were modest (< 2% annually). Among the 26 CQs, 14 were consistent with J-SSCG 2016 and 12 were newly introduced in 2020; both groups showed similarly limited changes in adherence. Adjusted intraclass correlation coefficients exceeded 10% for 22 CQs, indicating persistent between-hospital variation, which remained unchanged after the guideline's release.

conclusionsThis nationwide study identified persistent evidence-practice gaps, minimal improvements in adherence after J-SSCG 2020, and substantial interhospital variation that remained unaltered. These findings underscore the challenges of implementing guidelines in practice and highlight the need to better understand contextual barriers to standardized sepsis care in Japan.

Indexed as

Guideline AdherencePractice Guidelines as TopicSepsisAgedAged, 80 and overCohort StudiesDatabases, FactualEast Asian PeopleFemaleHumansInterrupted Time Series AnalysisJapanMaleMiddle AgedRetrospective StudiesShock, SepticAdherenceClinical practice guidelinesHospital variationInterrupted time seriesSepsis

Identifiers

PMID40462110
PMCPMC12135573

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Registered trials

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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.