Time to treatment and mortality during mandated emergency care for sepsis.
Open accessAbstract
BACKGROUND: In 2013, New York began requiring hospitals to follow protocols for the early identification and treatment of sepsis. However, there is controversy about whether more rapid treatment of sepsis improves outcomes in patients. METHODS: We studied data from patients with sepsis and septic shock that were reported to the New York State Department of Health from April 1, 2014, to June 30, 2016. Patients had a sepsis protocol initiated within 6 hours after arrival in the emergency department and had all items in a 3-hour bundle of care for patients with sepsis (i.e., blood cultures, broad-spectrum antibiotic agents, and lactate measurement) completed within 12 hours. Multilevel models were used to assess the associations between the time until completion of the 3-hour bundle and risk-adjusted mortality. We also examined the times to the administration of antibiotics and to the completion of an initial bolus of intravenous fluid. RESULTS: Among 49,331 patients at 149 hospitals, 40,696 (82.5%) had the 3-hour bundle completed within 3 hours. The median time to completion of the 3-hour bundle was 1.30 hours (interquartile range, 0.65 to 2.35), the median time to the administration of antibiotics was 0.95 hours (interquartile range, 0.35 to 1.95), and the median time to completion of the fluid bolus was 2.56 hours (interquartile range, 1.33 to 4.20). Among patients who had the 3-hour bundle completed within 12 hours, a longer time to the completion of the bundle was associated with higher risk-adjusted in-hospital mortality (odds ratio, 1.04 per hour; 95% confidence interval [CI], 1.02 to 1.05; P<0.001), as was a longer time to the administration of antibiotics (odds ratio, 1.04 per hour; 95% CI, 1.03 to 1.06; P<0.001) but not a longer time to the completion of a bolus of intravenous fluids (odds ratio, 1.01 per hour; 95% CI, 0.99 to 1.02; P=0.21). CONCLUSIONS: More rapid completion of a 3-hour bundle of sepsis care and rapid administration of antibiotics, but not rapid completion of an initial bolus of intravenous fluids, were associated with lower risk-adjusted in-hospital mortality. (Funded by the National Institutes of Health and others.).
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Implementing standardized bundles can help ensure timely and proper sepsis care and has been associated with reductions in mortality.
“Implementing standardized bundles can help ensure timely and proper sepsis care and has been associated with reductions in mortality [11-13].”
From Integrating a Machine Learning System Into Clinical Workflows: Qualitative Study (2020) · cites this paper as [13]
The observed reductions compare favorably with other sepsis intervention studies.
“The observed reductions in ICU length of stay (1.8 days), mechanical ventilation duration (2.3 days), and 28-day mortality (5.7%) are clinically meaningful and compare favorably with other sepsis intervention studies22,23.”
From Machine learning predicts sepsis deterioration trajectories. (2026) · cites this paper as [22]
The Discussion compares compliance with sepsis-care steps across studies, but does not compare reductions in ICU stay, ventilation duration, or mortality with those from other sepsis interventions. The Results address time to treatment and in-hospital mortality, not the claimed comparison (searched: comparative outcomes, ICU length of stay, ventilation duration, and 28-day mortality). (LLM, conf=0.76)
Experimental — accuracy not yet measuredIn a study of 49,331 patients treated at 149 New York hospitals, each additional hour from ED arrival to antimicrobial administration was associated with 1.04 increased odds of in-hospital mortality (p < 0.001), with 1.07 for patients receiving vasopressors and 1.01 for patients not on vasopressors.
“In a study of 49,331 patients treated at 149 New York hospitals, each additional hour of time from ED arrival to administration of antimicrobials was associated with 1.04 increased odds of in-hospital mortality, p < 0.001 (1.07 (95% CI 1.05–1.09) for patients receiving vasopressors vs. 1.01 (95% CI 0.99–1.04) for patients not on vasopressors) [98].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [98]
In patients with sepsis without shock, the association between time to antimicrobials and mortality within the first few hours from presentation is less consistent.
“In patients with sepsis without shock, the association between time to antimicrobials and mortality within the first few hours from presentation is less consistent [98, 110].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [98]
The mortality reduction associated with early antimicrobials appears strongest in patients with septic shock, with weaker associations in patients without septic shock.
“The mortality reduction associated with early antimicrobials appears strongest in patients with septic shock, where a number of studies have reported a strong association between time-to-antibiotics and death in patients with septic shock but weaker associations in patients without septic shock [98, 109, 110].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [98]
Observational studies suggest that mortality may increase after intervals exceeding 3-5 h from hospital arrival and/or sepsis recognition.
“Observational studies do, however, suggest that mortality may increase after intervals exceeding 3–5 h from hospital arrival and/or sepsis recognition [98, 111, 119, 120].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [98]
Early administration of appropriate antimicrobials is one of the most effective interventions to reduce mortality in patients with sepsis.
“Early administration of appropriate antimicrobials is one of the most effective interventions to reduce mortality in patients with sepsis [96–98].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [98]
Early administration of appropriate antimicrobial therapy can be life-saving in patients with sepsis.
“Early administration of appropriate antimicrobial therapy can be life-saving in patients with sepsis”
From Trends in empiric broad-Spectrum antibiotic use for suspected community-onset Sepsis in US hospitals (2024) · cites this paper as [1]
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Cites
Surviving Sepsis Campaign: International guidelines for management of sepsis and septic shock: 2016.
Rhodes, A., Evans, L. E., Alhazzani, W., Levy, M. M., Antonelli, M., Ferrer, R., Kumar, A., Sevransky, J. E., Sprung, C. L., Nunnally, M. E., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4683-6 · Cited by 6,621 · see citing works
Self-citation2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference
Levy, M. M., Fink, M. P., Marshall, J. C., Abraham, E. H., Angus, D. C., Cook, D., Cohen, J., Opal, S. M., Vincent, J., & Ramsay, G. (2003) · Critical Care Medicine · doi:10.1097/01.ccm.0000050454.01978.3b · Cited by 5,976 · see citing works
Self-citationSeymour, C. W., Liu, V. X., Iwashyna, T. J., Brunkhorst, F. M., Rea, T. D., Scherag, A., Rubenfeld, G., Kahn, J. M., Shankar-Hari, M., Singer, M., et al. (2016) · JAMA · doi:10.1001/jama.2016.0288 · Cited by 3,939 · see citing works
Self-citationSepsis in European intensive care units: Results of the SOAP study*
Vincent, J., Sakr, Y. L., Sprung, C. L., Ranieri, V. M., Reinhart, K., Gerlach, H., Moreno, R. P., Carlet, J. M., Gall, J. L., & Payen, D. M. (2006) · Critical Care Medicine · doi:10.1097/01.ccm.0000194725.48928.3a · Cited by 2,841 · see citing works
Empiric Antibiotic Treatment Reduces Mortality in Severe Sepsis and Septic Shock From the First Hour
Ferrer, R., Martín‐Loeches, I., Phillips, G. S., Osborn, T. M., Townsend, S. R., Dellinger, R. P., Artigas, A., Schorr, C., & Levy, M. M. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000330 · Cited by 1,487 · see citing works
Self-citationBenchmarking the Incidence and Mortality of Severe Sepsis in the United States*
Gaieski, D. F., Edwards, J. M., Kallan, M. J., & Carr, B. G. (2013) · Critical Care Medicine · doi:10.1097/ccm.0b013e31827c09f8 · Cited by 1,322 · see citing works
The timing of early antibiotics and hospital mortality in sepsis.
Liu, V. X., Fielding-Singh, V., Greene, J. D., Baker, J. M., Iwashyna, T. J., Bhattacharya, J., & Escobar, G. J. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201609-1848oc · Cited by 1,006 · see citing works
Self-citationJansen, T. C., van Bommel, J., Schoonderbeek, F. J., Sleeswijk Visser, S. J., van der Klooster, J. M., Lima, A. P., Willemsen, S. P., & Bakker, J. (2010) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200912-1918oc · Cited by 894 · see citing works
Early, Goal-Directed Therapy for Septic Shock — A Patient-Level Meta-Analysis
The PRISM Investigators (2017) · New England Journal of Medicine · doi:10.1056/nejmoa1701380 · Cited by 600 · see citing works
(2009) · doi:10.1007/978-0-387-87959-8 · Cited by 554 · see citing works
Sterling, S. A., Miller, W. R., Pryor, J., Puskarich, M. A., & Jones, A. E. (2015) · Critical Care Medicine · doi:10.1097/ccm.0000000000001142 · Cited by 434 · see citing works
Puskarich, M. A., Trzeciak, S., Shapiro, N. I., Arnold, R. C., Horton, J. M., Studnek, J. R., Kline, J. A., & Jones, A. E. (2011) · Critical Care Medicine · doi:10.1097/ccm.0b013e31821e87ab · Cited by 376 · see citing works
Assessment and Control for Confounding by Indication in Observational Studies
Psaty, B. M., Koepsell, T. D., Lin, D., Weiss, N. S., Siscovick, D. S., Rosendaal, F. R., Pahor, M., & Furberg, C. D. (1999) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1999.tb01603.x · Cited by 363 · see citing works
Applying Quantitative Bias Analysis to Epidemiologic Data
Fink, A. K., Fox, M. P., & Lash, T. L. (2009) · Statistics in the health sciences · doi:10.1007/b97920 · Cited by 354 · see citing works
Regulatory Mandates for Sepsis Care — Reasons for Caution
Rhee, C., Gohil, S. K., & Klompas, M. (2014) · New England Journal of Medicine · doi:10.1056/nejmp1400276 · Cited by 232 · see citing works
Kumar, A., Haery, C., Paladugu, B. P., Kumar, A., Symeoneides, S., Taiberg, L., Osman, J., Trenholme, G. M., Opal, S. M., Goldfarb, R. D., et al. (2005) · The Journal of Infectious Diseases · doi:10.1086/498909 · Cited by 222 · see citing works
Ranking Hospitals on Surgical Mortality: The Importance of Reliability Adjustment
Dimick, J. B., Staiger, D. O., & Birkmeyer, J. D. (2010) · Health Services Research · doi:10.1111/j.1475-6773.2010.01158.x · Cited by 221 · see citing works
Building Multivariable Regression Models with Continuous Covariates in Clinical Epidemiology
Sauerbrei, W., & Royston, P. J. (2005) · Methods of Information in Medicine · doi:10.1055/s-0038-1634008 · Cited by 198 · see citing works
Diagnosing sepsis is subjective and highly variable: A survey of intensivists using case vignettes.
Rhee, C., Kadri, S. S., Danner, R. L., Suffredini, A. F., Massaro, A. F., Kitch, B. T., Lee, G., & Klompas, M. (2016) · Critical Care · doi:10.1186/s13054-016-1266-9 · Cited by 187 · see citing works
Quality improvement in acute stroke
Gropen, T., Gagliano, P. J., Blake, C. A., Sacco, R. L., Kwiatkowski, T., Richmond, N. J., Leifer, D., Libman, R., Azhar, S., & Daley, M. (2006) · Neurology · doi:10.1212/01.wnl.0000223622.13641.6d · Cited by 147 · see citing works
Guillamet, C. V., Scolari, M., Zilberberg, M. D., Shorr, A. F., Micek, S. T., & Kollef, M. H. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000516 · Cited by 118 · see citing works
National variation in United States sepsis mortality: a descriptive study
Wang, H. E., Devereaux, R. S., Yealy, D. M., Safford, M. M., & Howard, G. (2010) · International Journal of Health Geographics · doi:10.1186/1476-072x-9-9 · Cited by 106 · see citing works
Hospital Case Volume and Outcomes among Patients Hospitalized with Severe Sepsis
Walkey, A. J., & Wiener, R. S. (2014) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201311-1967oc · Cited by 93 · see citing works
Banta, J. E., Joshi, K. P., Beeson, W. L., & Nguyen, H. B. (2012) · Critical Care Medicine · doi:10.1097/ccm.0b013e31825bc92f · Cited by 53 · see citing works
Hospital Factors Associated With Discharge Bias in ICU Performance Measurement*
Reineck, L. A., Pike, F., Le, T. Q., Cicero, B. D., Iwashyna, T. J., & Kahn, J. M. (2014) · Critical Care Medicine · doi:10.1097/ccm.0000000000000132 · Cited by 44 · see citing works
Self-citationCooke, C. R., & Iwashyna, T. J. (2014) · JAMA · doi:10.1001/jama.2014.11350 · Cited by 36 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Rudd, K. E., Johnson, S. C., Agesa, K. M., Shackelford, K. A., Tsoi, D., Kievlan, D. R., Colombara, D. V., Ikuta, K. S., Kissoon, N., Finfer, S., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(19)32989-7 · Cited by 7,971 · see citing works
Self-citationSurviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021.
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000005337 · Cited by 2,935 · see citing works
Self-citationCecconi, M., Evans, L., Levy, M., & Rhodes, A. (2018) · The Lancet · doi:10.1016/s0140-6736(18)30696-2 · Cited by 2,254 · see citing works
Self-citationIkuta, K. S., Swetschinski, L. R., Robles Aguilar, G., Sharara, F., Mestrovic, T., Gray, A. P., Davis Weaver, N., Wool, E. E., Han, C., Gershberg Hayoon, A., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(22)02185-7 · Cited by 2,235 · see citing works
The surviving sepsis campaign bundle: 2018 update
Levy, M. M., Evans, L. E., & Rhodes, A. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5085-0 · Cited by 1,445 · see citing works
Self-citationEnhancing Recovery From Sepsis: A Review
Prescott, H. C., & Angus, D. C. (2018) · JAMA · doi:10.1001/jama.2017.17687 · Cited by 1,059 · see citing works
Self-citationAn interpretable machine learning model for accurate prediction of sepsis in the ICU
Nemati, S., Holder, A., Razmi, F., Stanley, M. D., Clifford, G. D., & Buchman, T. G. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000002936 · Cited by 832 · see citing works
Fleuren, L. M., Klausch, T. L. T., Zwager, C. L., Schoonmade, L. J., Guo, T., Roggeveen, L. F., Swart, E. L., Girbes, A. R. J., Thoral, P., Ercole, A., et al. (2020) · Intensive Care Medicine · doi:10.1007/s00134-019-05872-y · Cited by 755 · see citing works
Malbrain, M. L. N. G., Van Regenmortel, N., Saugel, B., De Tavernier, B., Van Gaal, P.-J., Joannes-Boyau, O., Teboul, J.-L., Rice, T. W., Mythen, M., & Monnet, X. (2018) · Annals of Intensive Care · doi:10.1186/s13613-018-0402-x · Cited by 632 · see citing works
The Surviving Sepsis Campaign Bundle: 2018 Update
Levy, M. M., Evans, L. E., & Rhodes, A. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003119 · Cited by 679 · see citing works
Self-citationKlein, R., & Hultgren, S. (2020) · Nature Reviews Microbiology · doi:10.1038/s41579-020-0324-0 · Cited by 479 · see citing works
Early prediction of circulatory failure in the intensive care unit using machine learning
Hyland, S. L., Faltys, M., Hüser, M., Lyu, X., Gumbsch, T., Esteban, C., Bock, C., Horn, M., Moor, M., Rieck, B., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0789-4 · Cited by 477 · see citing works
Meyer, N. J., & Prescott, H. C. (2024) · New England Journal of Medicine · doi:10.1056/nejmra2403213 · Cited by 436 · see citing works
Self-citationRhee, C., Kadri, S. S., Dekker, J. P., Danner, R. L., Chen, H.-C., Fram, D., Zhang, F., Wang, R., Klompas, M., & Program, F. T. C. P. E. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.2899 · Cited by 397 · see citing works
Goh, K. H., Wang, L., Yeow, A. Y. K., Poh, H., Li, K., Yeow, J. J. L., & Tan, G. Y. H. (2021) · Nature Communications · doi:10.1038/s41467-021-20910-4 · Cited by 415 · see citing works
Perforated and bleeding peptic ulcer: WSES guidelines
Tarasconi, A., Coccolini, F., Biffl, W. L., Tomasoni, M., Ansaloni, L., Picetti, E., Molfino, S., Shelat, V. G., Cimbanassi, S., Weber, D., et al. (2020) · World Journal of Emergency Surgery · doi:10.1186/s13017-019-0283-9 · Cited by 425 · see citing works
Adams, R., Henry, K. E., Sridharan, A., Soleimani, H., Zhan, A., Rawat, N., Johnson, L., Hager, D. N., Cosgrove, S. E., Markowski, A., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01894-0 · Cited by 365 · see citing works
Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis
Evans, I. V. R., Phillips, G. S., Alpern, E. R., Angus, D. C., Friedrich, M., Kissoon, N., Lemeshow, S., Levy, M., Parker, M., Terry, K. M., et al. (2018) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.2018.9071 · Cited by 312 · see citing works
Self-citationTokyo Guidelines 2018: management bundles for acute cholangitis and cholecystitis
Mayumi, T., Okamoto, K., Takada, T., Strasberg, S. M., Solomkin, J. S., Schlossberg, D., Pitt, H. A., Yoshida, M., Gomi, H., Miura, F., et al. (2018) · Journal of Hepato-Biliary-Pancreatic Sciences · doi:10.1002/jhbp.519 · Cited by 311 · see citing works
(BIOHAZ), E. P. O. B. H., Koutsoumanis, K. P., Allende, A., Álvarez‐Ordóñez, A., Bolton, D., Bover‐Cid, S., Chemaly, M., Davies, R., Cesare, A. D., Herman, L., et al. (2021) · EFSA Journal · doi:10.2903/j.efsa.2021.6651 · Cited by 329 · see citing works
Weis, C., Cuénod, A., Rieck, B., Dubuis, O., Graf, S., Lang, C., Oberle, M., Brackmann, M., Søgaard, K. K., Osthoff, M. F., et al. (2022) · Nature Medicine · doi:10.1038/s41591-021-01619-9 · Cited by 314 · see citing works
Triage Performance in Emergency Medicine: A Systematic Review
Hinson, J. S., Martínez, D. A., Cabral, S., George, K., Whalen, M. M., Hansoti, B., & Levin, S. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.09.022 · Cited by 298 · see citing works
Prehospital antibiotics in the ambulance for sepsis: A multicentre, open label, randomised trial.
Alam, N., Oskam, E., Stassen, P. M., Exter, P. V., van de Ven, P. M., Haak, H. R., Holleman, F., Zanten, A. V., Leeuwen-Nguyen, H. V., Bon, V., et al. (2018) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(17)30469-1 · Cited by 290 · see citing works
The roles of macrophage polarization in the host immune response to sepsis
Chen, X., Liu, Y., Gao, Y., Shou, S., & Chai, Y. (2021) · International Immunopharmacology · doi:10.1016/j.intimp.2021.107791 · Cited by 289 · see citing works
Kadri, S. S., Lai, Y. L., Warner, S., Strich, J. R., Babiker, A., Ricotta, E., Demirkale, C. Y., Dekker, J. P., Palmore, T. N., Rhee, C., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30477-1 · Cited by 284 · see citing works
Surviving sepsis campaign: research priorities for sepsis and septic shock
Coopersmith, C. M., Backer, D. D., Deutschman, C. S., Ferrer, R., Lat, I., Machado, F. R., Martin, G. S., Martín‐Loeches, I., Nunnally, M., Antonelli, M. M., et al. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5175-z · Cited by 283 · see citing works
Self-citationFernando, S. M., Tran, A., Taljaard, M., Cheng, W., Rochwerg, B., Seely, A. J. E., & Perry, J. J. (2018) · Annals of Internal Medicine · doi:10.7326/m17-2820 · Cited by 281 · see citing works
Early Prediction of Sepsis From Clinical Data: The PhysioNet/Computing in Cardiology Challenge 2019
Reyna, M. A., Josef, C. S., Jeter, R., Shashikumar, S. P., Westover, M. B., Nemati, S., Clifford, G. D., & Sharma, A. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004145 · Cited by 383 · see citing works
Rationalizing antimicrobial therapy in the ICU: a narrative review
Timsit, J., Bassetti, M., Cremer, O. L., Daikos, G. L., Waele, J. J. D., Kalil, A. C., Kipnis, É., Kollef, M. H., Laupland, K. B., Paiva, J.-A., et al. (2019) · Intensive Care Medicine · doi:10.1007/s00134-019-05520-5 · Cited by 275 · see citing works
Bloodstream infections – Standard and progress in pathogen diagnostics
Lamy, B., Sundqvist, M., & Idelevich, E. A. (2020) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2019.11.017 · Cited by 250 · see citing works
Gut-liver crosstalk in sepsis-induced liver injury
Sun, J., Zhang, J., Wang, X., Ji, F., Ronco, C., Tian, J., & Yin, Y. (2020) · Critical Care · doi:10.1186/s13054-020-03327-1 · Cited by 250 · see citing works
ED door-to-antibiotic time and long-term mortality in sepsis.
Peltan, I. D., Brown, S. M., Bledsoe, J. R., Sorensen, J., Samore, M. H., Allen, T. L., & Hough, C. L. (2019) · Chest · doi:10.1016/j.chest.2019.02.008 · Cited by 243 · see citing works
Acute-on-Chronic Liver Failure Clinical Guidelines
Bajaj, J. S., O’Leary, J. G., Lai, J. C., Wong, F. S.-H., Long, M. D., Wong, R. J., & Kamath, P. S. (2022) · The American Journal of Gastroenterology · doi:10.14309/ajg.0000000000001595 · Cited by 247 · see citing works
Cheng, M. P., Stenstrom, R. J., Paquette, K., Stabler, S. N., Akhter, M., Davidson, A. C., Gavric, M., Lawandi, A., Jinah, R., Saeed, Z. A., et al. (2019) · Annals of Internal Medicine · doi:10.7326/m19-1696 · Cited by 240 · see citing works
Sepsis and septic shock: Guideline-based management
Dugar, S. P., Choudhary, C., & Duggal, A. (2020) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.87a.18143 · Cited by 231 · see citing works
Vasopressor therapy in critically ill patients with shock
Russell, J. A. (2019) · Intensive Care Medicine · doi:10.1007/s00134-019-05801-z · Cited by 236 · see citing works
Ljungström, L., Pernestig, A.-K., Jacobsson, G., Andersson, R., Usener, B., & Tilevik, D. (2017) · PLOS ONE · doi:10.1371/journal.pone.0181704 · Cited by 219 · see citing works
The Pathophysiology of Sepsis-Associated AKI
Kuwabara, S., Goggins, E. S., & Okusa, M. D. (2022) · Clinical Journal of the American Society of Nephrology · doi:10.2215/cjn.00850122 · Cited by 232 · see citing works
Falcone, M., Bassetti, M., Tiseo, G., Giordano, C., Elia, N., Russo, A., Graziano, E., Tagliaferri, E., Leonildi, A., Barnini, S., et al. (2020) · Critical Care · doi:10.1186/s13054-020-2742-9 · Cited by 230 · see citing works
Egi, M., Ogura, H., Yatabe, T., Atagi, K., Inoue, S., Iba, T., Kakihana, Y., Kawasaki, T., Kushimoto, S., Kuroda, Y., et al. (2021) · Journal of Intensive Care · doi:10.1186/s40560-021-00555-7 · Cited by 226 · see citing works
Kollef, M. H., Torres, A., Shorr, A. F., Martín‐Loeches, I., & Micek, S. T. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004783 · Cited by 225 · see citing works
Baghela, A., Pena, O. M., Lee, A. H., Baquir, B., Falsafi, R., An, A., Farmer, S. W., Hurlburt, A., Mondragon-Cardona, A., Rivera, J. D., et al. (2022) · EBioMedicine · doi:10.1016/j.ebiom.2021.103776 · Cited by 219 · see citing works
Rhee, C., Chiotos, K., Cosgrove, S. E., Heil, E. L., Kadri, S. S., Kalil, A. C., Gilbert, D. N., Masur, H., Septimus, E. J., Sweeney, D. A., et al. (2021) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa059 · Cited by 191 · see citing works
Gong, S., Yan, Z., Liu, Z., Niu, M., Fang, H., Li, N., Huang, C., Li, L., Chen, G., Luo, H., et al. (2019) · Hepatology · doi:10.1002/hep.30361 · Cited by 188 · see citing works
"The human body is a black box": supporting clinical decision-making with deep learning
Sendak, M., Elish, M. C., Gao, M., Futoma, J., Ratliff, W., Nichols, M., Bedoya, A., Balu, S., & O'Brien, C. (2020) · Proceedings of the 2020 Conference on Fairness, Accountability, and Transparency · doi:10.1145/3351095.3372827 · Cited by 196 · see citing works
Sepsis in the burn patient: a different problem than sepsis in the general population
Greenhalgh, D. G. (2017) · Burns & Trauma · doi:10.1186/s41038-017-0089-5 · Cited by 192 · see citing works
Sepsis and septic shock: current approaches to management
Thompson, K., Venkatesh, B., & Finfer, S. R. (2019) · Internal Medicine Journal · doi:10.1111/imj.14199 · Cited by 191 · see citing works
Antibiotics for sepsis-finding the equilibrium.
Klompas, M., Calandra, T., & Singer, M. (2018) · JAMA · doi:10.1001/jama.2018.12179 · Cited by 183 · see citing works
Fluid Therapy for Critically Ill Adults With Sepsis: A Review
Zampieri, F. G., Bagshaw, S. M., & Semler, M. W. (2023) · JAMA · doi:10.1001/jama.2023.7560 · Cited by 184 · see citing works
Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock
Kuttab, H. I., Lykins, J. D., Hughes, M. D., Wroblewski, K., Keast, E. P., Kukoyi, O., Kopec, J. A., Hall, S., & Ward, M. A. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003960 · Cited by 176 · see citing works
Sepsis: Early Recognition and Optimized Treatment
Kim, H. I., & Park, S. (2018) · Tuberculosis & respiratory diseases · doi:10.4046/trd.2018.0041 · Cited by 178 · see citing works
IDSA Sepsis Task Force, Kalil, A. C., Gilbert, D. N., Winslow, D. L., Masur, H., & Klompas, M. (2017) · Clinical Infectious Diseases · doi:10.1093/cid/cix997 · Cited by 178 · see citing works
Im, Y., Kang, D., Ko, R., Lee, Y. J., Lim, S. Y., Park, S., Na, S. J., Chung, C. R., Park, M. H., Oh, D. K., et al. (2022) · Critical Care · doi:10.1186/s13054-021-03883-0 · Cited by 182 · see citing works
Antimicrobial-associated harm in critical care: a narrative review
Arulkumaran, N., Routledge, M., Schlebusch, S., Lipman, J., & Conway Morris, A. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-05929-3 · Cited by 175 · see citing works
Peden, C. J., Aggarwal, G., Aitken, R., Anderson, I. D., Foss, N. B., Cooper, Z. R., Dhesi, J. K., French, W. B., Grant, M. C., Hammarqvist, F., et al. (2021) · World Journal of Surgery · doi:10.1007/s00268-021-05994-9 · Cited by 191 · see citing works
Ospina-Tascón, G. A., Glenn Hernández, P., Alvarez, I., Calderón, L., Manzano-Núñez, R., Sánchez, Á., Quiñones, E., Ruíz, J., Aldana, J. L., Teboul, J., et al. (2020) · Critical Care · doi:10.1186/s13054-020-2756-3 · Cited by 169 · see citing works
Identification and characterization of neutrophil heterogeneity in sepsis
Qi, X., Yu, Y., Sun, R., Huang, J., Liu, L., Yang, Y., Tao, R., & Sun, B. (2021) · Critical Care · doi:10.1186/s13054-021-03481-0 · Cited by 173 · see citing works
Integrating a Machine Learning System Into Clinical Workflows: Qualitative Study
Sandhu, S., Lin, A. L., Brajer, N., Sperling, J., Ratliff, W., Bedoya, A. D., Balu, S., O'Brien, C., & Sendak, M. P. (2020) · Journal of Medical Internet Research · doi:10.2196/22421 · Cited by 168 · see citing works
Seymour, C. W., Gómez, H., Chang, C. H., Clermont, G., Kellum, J. A., Kennedy, J. N., Yende, S. P., & Angus, D. C. (2017) · Critical Care · doi:10.1186/s13054-017-1836-5 · Cited by 168 · see citing works
Self-citationFilbin, M. R., Lynch, J., Gillingham, T. D., Thorsen, J. E., Pasakarnis, C. L., Nepal, S., Matsushima, M., Rhee, C., Heldt, T., & Reisner, A. T. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003260 · Cited by 168 · see citing works
Surviving Sepsis Campaign Research Priorities 2023
Backer, D. D., Deutschman, C. S., Hellman, J., Myatra, S. N., Ostermann, M., Prescott, H. C., Talmor, D. S., Antonelli, M. M., Azevedo, L. C. P., Bauer, S. R., et al. (2024) · Critical Care Medicine · doi:10.1097/ccm.0000000000006135 · Cited by 173 · see citing works
Self-citationManagement of sepsis and septic shock in the emergency department
Gavelli, F., Castello, L. M., & Avanzi, G. C. (2021) · Internal and Emergency Medicine · doi:10.1007/s11739-021-02735-7 · Cited by 161 · see citing works
on behalf of JAAM FORECAST group, Abe, T., Ogura, H., Shiraishi, A., Kushimoto, S., Saitoh, D., Fujishima, S., Mayumi, T., Shiino, Y., Nakada, T., et al. (2018) · Critical Care · doi:10.1186/s13054-018-2186-7 · Cited by 159 · see citing works
Mangalore, R. P., Ashok, A., Lee, S. J., Romero, L., Peel, T. N., Udy, A. A., & Peleg, A. Y. (2022) · Clinical Infectious Diseases · doi:10.1093/cid/ciac506 · Cited by 159 · see citing works
Strich, J. R., Heil, E. L., & Masur, H. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa221 · Cited by 158 · see citing works
Early Prediction of Sepsis from Clinical Data: The PhysioNet/Computing in Cardiology Challenge 2019
Reyna, M. A., Shashikumar, S. P., Moody, B., Gu, P., Sharma, A., Nemati, S., & Clifford, G. D. (2019) · Computing in cardiology · doi:10.22489/cinc.2019.412 · Cited by 156 · see citing works
Van Heuverswyn, J., Valik, J. K., Desirée van der Werff, S., Hedberg, P., Giske, C., & Nauclér, P. (2023) · Clinical Infectious Diseases · doi:10.1093/cid/ciac727 · Cited by 163 · see citing works
Timing of antibiotic therapy in the ICU
Kollef, M. H., Shorr, A. F., Bassetti, M., Timsit, J.-F., Micek, S. T., Michelson, A. P., & Garnacho-Montero, J. (2021) · Critical Care · doi:10.1186/s13054-021-03787-z · Cited by 161 · see citing works
Integrated Biosensor for Rapid and Point-of-Care Sepsis Diagnosis
Min, J., Nothing, M., Coble, B. W., Zheng, H., Park, J., Im, H., Weber, G. F., Castro, C. M., Świrski, F. K., Weissleder, R., et al. (2018) · ACS Nano · doi:10.1021/acsnano.7b08965 · Cited by 150 · see citing works
Kahn, J. M., Davis, B. S., Yabes, J. G., Chang, C.-C. H., Chong, D. H., Hershey, T. B., Martsolf, G. R., & Angus, D. C. (2019) · JAMA · doi:10.1001/jama.2019.9021 · Cited by 149 · see citing works
Fernando, S. M., Rochwerg, B. N., & SEELY, A. J. E. (2018) · Canadian Medical Association Journal · doi:10.1503/cmaj.170149 · Cited by 154 · see citing works
Karvellas, C. J., Bajaj, J. S., Kamath, P. S., Napolitano, L. M., O’Leary, J. G., Solà, E., Subramanian, R., Wong, F. S.-H., & Asrani, S. K. (2023) · Hepatology · doi:10.1097/hep.0000000000000671 · Cited by 164 · see citing works
Self, W. H., Semler, M. W., Bellomo, R., Brown, S. M., deBoisblanc, B. P., Exline, M. C., Ginde, A. A., Grissom, C. K., Janz, D. R., Jones, A. E., et al. (2018) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2018.03.039 · Cited by 144 · see citing works
Point-of-care sensors for the management of sepsis
Reddy, B., Hassan, U., Seymour, C., Angus, D. C., Isbell, T. S., White, K., Weir, W., Yeh, L., Vincent, A., & Bashir, R. (2018) · Nature Biomedical Engineering · doi:10.1038/s41551-018-0288-9 · Cited by 142 · see citing works
Self-citationShortridge, D., Gales, A. C., Streit, J. M., Huband, M. D., Tsakris, A., & Jones, R. N. (2019) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofy343 · Cited by 144 · see citing works
Fleischmann-Struzek, C., Mikolajetz, A., Schwarzkopf, D., Cohen, J., Hartog, C. S., Pletz, M. W., Gastmeier, P., & Reinhart, K. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5377-4 · Cited by 140 · see citing works
Levy, M. M., Gesten, F. C., Phillips, G. S., Terry, K. M., Seymour, C. W., Prescott, H. C., Friedrich, M., Iwashyna, T. J., Osborn, T., & Lemeshow, S. (2018) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201712-2545oc · Cited by 137 · see citing works
Self-citationJorgensen, S. C. J., Trinh, T. D., Zasowski, E. J., Lagnf, A. M., Bhatia, S., Melvin, S. M., Steed, M. E., Simon, S. P., Estrada, S. J., Morrisette, T., et al. (2019) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofz522 · Cited by 135 · see citing works
Husabø, G., Nilsen, R. M., Flaatten, H. K., Solligård, E., Frich, J. C., Bondevik, G. T., Braut, G. S., Walshe, K., Harthug, S., & Hovlid, E. (2020) · PLoS ONE · doi:10.1371/journal.pone.0227652 · Cited by 131 · see citing works
Rhee, C., Filbin, M. R., Massaro, A. F., Bulger, A. L., McEachern, D., Tobin, K. A., Kitch, B. T., Thurlo-Walsh, B., Kadar, A. Y., Koffman, A., et al. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003261 · Cited by 133 · see citing works
Henry, K. E., Adams, R., Parent, C., Soleimani, H., Sridharan, A., Johnson, L., Hager, D. N., Cosgrove, S. E., Markowski, A., Klein, E. Y., et al. (2022) · Nature Medicine · doi:10.1038/s41591-022-01895-z · Cited by 127 · see citing works
Ohnuma, T., Chihara, S., Costin, B., Treggiari, M. M., Bartz, R. R., Raghunathan, K., & Krishnamoorthy, V. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.49353 · Cited by 127 · see citing works
A Critical Analysis of the Literature on Time-to-Antibiotics in Suspected Sepsis
Weinberger, J., Rhee, C., & Klompas, M. (2020) · The Journal of Infectious Diseases · doi:10.1093/infdis/jiaa146 · Cited by 125 · see citing works
Zhang, Z., Bokhari, F., Guo, Y., & Goyal, H. (2018) · Emergency Medicine Journal · doi:10.1136/emermed-2018-208032 · Cited by 121 · see citing works
Rhee, C., Wang, R., Zhang, Z., Fram, D., Kadri, S. S., & Klompas, M. (2019) · Critical Care Medicine · doi:10.1097/ccm.0000000000003817 · Cited by 122 · see citing works
Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021
Evans, L., Rhodes, A., Alhazzani, W., Antonelli, M., Coopersmith, C. M., French, C., Machado, F. R., Mcintyre, L., Ostermann, M., Prescott, H. C., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06506-y · Cited by 5,082 · see citing works
Self-citationS3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge
Deutsche Sepsis Gesellschaft e., V., Brunkhorst, F. M., Weigand, M. A., Pletz, M. W., Gastmeier, P., Lemmen, S., Meier‐Hellmann, A., Ragaller, M., Weyland, A., Marx, G., et al. (2020) · Medizinische Klinik - Intensivmedizin und Notfallmedizin · doi:10.1007/s00063-020-00685-0 · Cited by 119 · see citing works
Khwannimit, B., Bhurayanontachai, R., & Vattanavanit, V. (2017) · Journal of Critical Care · doi:10.1016/j.jcrc.2017.10.023 · Cited by 120 · see citing works
Fluid balance concepts in medicine: Principles and practice
Roumelioti, M., Glew, R. H., Khitan, Z. J., Rondon‐Berrios, H., Argyropoulos, C., Malhotra, D. K., Raj, D. S., Agaba, E. I., Rohrscheib, M. R., Murata, G. H., et al. (2018) · World Journal of Nephrology · doi:10.5527/wjn.v7.i1.1 · Cited by 120 · see citing works
An Explainable Artificial Intelligence Predictor for Early Detection of Sepsis
Yang, M., Liu, C., Wang, X., Li, Y., Gao, H., Liu, X., & Li, J. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004550 · Cited by 120 · see citing works
Moor, M., Bennett, N., Plečko, D., Horn, M., Rieck, B., Meinshausen, N., Bühlmann, P., & Borgwardt, K. (2023) · eClinicalMedicine · doi:10.1016/j.eclinm.2023.102124 · Cited by 118 · see citing works
Surviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock
Coopersmith, C. M., Backer, D. D., Deutschman, C. S., Ferrer, R., Lat, I., Machado, F. R., Martin, G. S., Martín‐Loeches, I., Nunnally, M., Antonelli, M. M., et al. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003225 · Cited by 117 · see citing works
Self-citationLearning to Detect Sepsis with a Multitask Gaussian Process RNN ClassifierPreprint
Futoma, J., Hariharan, S., & Heller, K. (2017) · arXiv (Cornell University) · doi:10.48550/arxiv.1706.04152 · Cited by 122 · see citing works
Yealy, D. M., Mohr, N. M., Shapiro, N. I., Venkatesh, A. K., Jones, A. E., & Self, W. H. (2021) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2021.02.006 · Cited by 119 · see citing works
Improving sepsis treatment by embracing diagnostic uncertainty.
Prescott, H. C., & Iwashyna, T. J. (2019) · Annals of the American Thoracic Society · doi:10.1513/annalsats.201809-646ps · Cited by 110 · see citing works
Self-citationAssociation Between Time to Source Control in Sepsis and 90-Day Mortality
Reitz, K. M., Kennedy, J. N., Li, S. R., Handzel, R. M., Tonetti, D. A., Neal, M. D., Zuckerbraun, B. S., Hall, D. E., Sperry, J. L., Angus, D. C., et al. (2022) · JAMA Surgery · doi:10.1001/jamasurg.2022.2761 · Cited by 112 · see citing works
Self-citationNauclér, P., Huttner, A. C., van Werkhoven, C. H., Singer, M., Tattevin, P., Einav, S., & Tängdén, T. (2020) · Clinical Microbiology and Infection · doi:10.1016/j.cmi.2020.02.032 · Cited by 113 · see citing works
Baghdadi, J. D., Brook, R. H., Uslan, D. Z., Needleman, J., Bell, D. S., Cunningham, W. E., & Wong, M. D. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.0183 · Cited by 110 · see citing works
Shankar‐Hari, M., Harrison, D. A., Ferrando-Vivas, P., Rubenfeld, G. D., & Rowan, K. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.4900 · Cited by 109 · see citing works
Machine learning for early detection of sepsis: an internal and temporal validation study
Bedoya, A. D., Futoma, J., Clement, M. E., Corey, K., Brajer, N., Lin, A., Simons, M. G., Gao, M., Nichols, M., Balu, S., et al. (2020) · JAMIA Open · doi:10.1093/jamiaopen/ooaa006 · Cited by 109 · see citing works
- Authors
- Seymour, C. W., Gesten, F., Prescott, H. C., Friedrich, M. E., Iwashyna, T. J., Phillips, G. S., Lemeshow, S., Osborn, T., Terry, K. M., & Levy, M. M.
- Affiliations
- New York State Department of Health (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2017-06-08
- Volume
- 376
- Issue
- 23
- Pages
- 2235-2244
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC5538258
- OpenAlex
- W2614741637
- Semantic Scholar
- 62b9aa37782c55c987f30172befdf1a32ae2a027
- Cited by
- 2,225
- References
- 26
- Citations by year
- 2026: 254 · 2025: 215 · 2024: 245 · 2023: 266 · 2022: 279 · 2021: 241 · 2020: 267 · 2019: 233 · 2018: 176 · 2017: 46 · 2015: 1
- FWCI
- 154.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons@Becker (Washington University School of Medicine) (submittedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Health Services Research and Development (13-079, 11-109)
- National Institutes of Health
- National Cancer Institute (P30CA016058)
- National Institute of General Medical Sciences (K08GM115859, R35GM119519)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Health Sciences › Medicine › Emergency Medicine › Emergency and Acute Care Studies
- Keywords
- sepsis, septic shock, time to treatment, sepsis protocol, antibiotic administration, fluid bolus, in-hospital mortality, emergency department care, risk-adjusted mortality, blood culture, lactate measurement, broad-spectrum antibiotics
- MeSH terms
- Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Combined Modality Therapy, Emergency Treatment, Female, Fluid Therapy, Humans, Infusions, Intravenous, Male, Middle Aged, Retrospective Studies, Shock, Septic, Multivariate Analysis, Hospital Mortality, Sepsis, Clinical Audit, Time-to-Treatment
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