病院でのセプシスの死亡率と国家によるセプシス治療との関連
Jeremy M Kahn1,2, Billie S Davis1, Jonathan G Yabes3,4
1CRISMA Center, Department of Critical Care Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA
|July 17, 2019
まとめ
証拠に基づいたプロトコルを要求するニューヨーク州のセプシス規制は,セプシスに関連した死亡率を大幅に減少させました. この研究では,対照州と比較して,ニューヨークでのセプシス死亡率がより大きく低下し,強制的なセプシス治療の有効性を実証しました.
科学分野:
- 医療政策
- 感染症 管理
- 公衆衛生の監視
背景:
- 2013年,ニューヨーク州は病院に証拠に基づいたセプシス管理プロトコルとデータ報告を義務付けました.
- 患者のアウトカムに対するこれらのセプシス規制の影響は未検討のままである.
研究 の 目的:
- ニューヨーク州のセプシス規制と 入院した患者のアウトカムとの関連を評価する.
- 同様の権限のない州での検査結果と,ニューヨークのセプシスの結果を比較する.
主な方法:
- 2011年1月から2015年9月までのすべての支払者の退院データを分析したレトロスペクティブコホート研究.
- ニューヨークと4つの対照州 (FL,MD,MA,NJ) で結血病で入院した成人の患者も含まれています.
- 規制前の結果と規制後の結果を評価するために,比較的な中断されたタイムシリーズ分析を使用しました.
主要な成果:
- ニューヨーク州におけるセプシス規制は,対照国と比較して30日間の入院死亡率の有意な減少と関連していた (P=0. 02).
- クロストリジウム・ディフィシル感染率 (P< 0. 001) と入院期間 (P= 0. 04) の有意な相対的な減少が観察されました.
- ICU 入院率 (P=0. 09) は有意な差異は認められなかったが,中央静脈カテーテル使用率 (P=0. 02) は有意に増加した.
結論:
- ニューヨークで義務付けられたプロトコルのセプシス治療は,対照州よりもセプシスによる死亡率の大幅な減少と関連していた.
- 研究結果は 州全体のセプシス規制が 患者の治療結果を改善する効果があることを示唆している.
- ニューヨーク州と比較州間の死亡率の違いにより,一般化が制限される可能性があります.
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