Journal Club Summary
Seymour CW, et al.
Journal N Engl J Med. 2017 Jun 8;376(23):2235-2244.
State Sepsis Mandates – A New Era for Regulation of Hospital Quality.
Hershey TB, et al.
N Engl J Med. 2017 May 21.
Methodology Score: 3.5/5
Usefulness Score: 3/5
This large retrospective review of observational data from 185 hospitals (49,331 patients) with severe sepsis or septic shock found that 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. We exercised caution in our interpretation of these results given the potential for confounders despite the authors’ attempt to account for them in their supplementary analysis, and we did not find it useful with regards to changing our current approach to the management of patients with severe sepsis or septic shock.
By: Dr. Leo Carroll
Epi lesson – Randomization Procedures
When reviewing a randomized trial, it is critical to determine how the randomization was conducted. Not all randomization schemes are created equal. Optimal randomization uses computer generated randomization or random tables. Quasi-experimental studies use pseudo-randomization techniques such as allocation based on alternating days of the week or date of birth. The reader can verify that randomization was conducted appropriately by examining participant characteristics and determining if the groups appear balanced.