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严重败血症和败血症冲击管理捆绑 (SEP-1) 合规性和实施对败血症患者死亡率的影响:系统性审查

James S Ford¹, Joseph C Morrison², May Kyaw³

¹Department of Emergency Medicine, University of California San Diego, San Diego, California (J.S.F.).

Annals of internal medicine

|February 17, 2025

概括

这次审查没有发现有力证据表明严重败血症和败血症冲击管理捆绑 (SEP-1) 改善败血症死亡率. 医疗保险和医疗补助服务中心 (CMS) 应该重新考虑将其纳入基于价值的采购计划.

科学领域:

关键护理医学关键护理医学
医疗保健服务研究医疗服务研究
提高质量提高质量

背景情况:

医疗保险和医疗补助服务中心 (CMS) 严重败血症和败血症冲击管理包 (SEP-1) 已纳入医院价值基础采购 (VBP) 计划.
这种纳入旨在鼓励改善败血症护理和患者的治疗结果.

研究的目的:

批判性地评估现有的关于SEP-1合规和实施对败血症相关死亡率的影响的科学证据.
确定当前的证据是否支持SEP-1在减少败血症死亡的有效性.

主要方法:

对评估成年败血症患者SEP-1规范定义的3或6小时败血症捆绑的研究进行系统审查.
在主要数据库 (PubMed,科学网,EMBASE,CINAHL,Cochrane图书馆) 进行了搜索,截至2024年11月26日.
使用GRADE和国家质量论坛标准评估证据质量;两位独立作者评估了偏见风险.

主要成果:

在包含的17项观察性研究中,12项研究了SEP-1合规性和死亡率,只有5项显示出统计学上显著的益处,通常具有方法上的限制.
五项研究评估了SEP-1的实施,只有一个研究表明了显著的益处,这些研究没有考虑到实施前的死亡率趋势.
所有纳入的研究都是观察性研究,没有一项具有低偏差风险的研究,这表明证据库存在重大局限性.

结论:

目前支持SEP-1合规或实施减少败血症死亡率的证据质量低,缺乏稳定性.
鉴于研究的方法异质性和观察性质,进行元分析是不可能的.
由于其有效性的证据不足,CMS应重新考虑将SEP-1纳入医院VBP计划.

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