32-Improving Pediatric Sepsis Outcomes for All Children Together (IPSO FACTO): Interim Results
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Pediatrics, Sepsis, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Raina M. Paul


Introduction/Hypothesis: Timely management of pediatric sepsis is challenging, and previous QI collaboratives have struggled to demonstrate meaningful association between improved care and improved outcomes

Methods: Children's Hospital Association formed a QI collaborative focused on Improving Pediatric Sepsis Outcomes (IPSO). Sepsis research definitions were adapted, enabling automated identification of potential sepsis across the care continuum. IPSO Sepsis (IS) patients were identified in real-time and retrospectively using intent to treat criteria. IS was subdivided into IPSO Non-critical Sepsis (INS) and IPSO Critical Sepsis (ICS) cohorts, the latter likely having septic shock. Changes in measures over time were analyzed using statistical process control. Outcomes of cases compliant vs. non-compliant with care bundles were compared using Pearson Chi Square and Wilcoxon rank sum tests.

Results: Results included 33726 cases, from 40 children's hospitals, between Jan 2017 and Dec 2019. Use of recognition tools (screen, huddle, orderset) increased identification of IS over time (rate/1000 admissions: 23.1 to 29.9), although identification of ICS remained relatively unchanged (rate/1000 admissions: 8.8 to 8.4). Increased IS identification likely influenced IS outcomes, so only results for ICS patients are presented. Use of any recognition method improved from 61.2-67.7%. Time to first bolus and antibiotic improved from 36.9 to 34.5 min and 89.9 to 84.2 min respectively. Cases compliant with initial collaborative goals (Bolus within 20 min, Abx within 60 min and any recognition method) demonstrated similar 30-day sepsis attributable mortality compared with non-compliant cases (3.1% vs. 3.5%, p=0.233) but lower median (IQR) hospital days [6(4,16) vs. 7(4,13), p<0.001]. In cases compliant with relaxed care bundle goals (Bolus within 60 min, Abx within 180 min and any recognition method), both 30-day sepsis attributable mortality (2.4% vs. 4.6%, p<0.001) and median hospital days [6(4,12) vs. 9(4,19), p< 0.001] were lower. There was improvement in adherence to both bundles over time (23 to 27.9% and 52 to 56.7% respectively).

Conclusions: Timely identification of pediatric sepsis and resuscitation is associated with improved sepsis outcomes. Sustained improvement should focus on bundle adherence with higher reliability.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Sepsis
Knowledge Level Advanced
Membership Level Select
Tag Guidelines
Year 2021
Ipso Facto Study
quality improvement collaborative
pediatric sepsis
mortality reduction
septic shock prevention


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