Timely intervention: A meta-analysis of rapid recognition and management of sepsis in emergency settings

Background: Sepsis is a medical emergency that requires urgent recognition and management to limit consequential morbidity and mortality. Early recognition and management of sepsis, including early administration of antibiotics and fluids, can improve a patient's chance of survival; however, there remains variability in both the application and success of treating a sepsis patient with a care bundle. Objective: To systematically review and Meta-analyze the published literature for any outcomes of rapid recognition and management interventions for sepsis in an emergency context to improve the timing of key bundle components and associated clinical outcomes. Methods: A literature search was conducted, and we identified ten meta-analyses and systematic reviews of sepsis interventions, including sepsis alerting protocols, clinical decision support tools, and standardized sepsis care protocols. We utilized the data as available on study characteristics, design of the intervention, type of intervention, total sample size of participants, and outcomes to pool and synthesize the data. We recorded effect sizes for the administration of antibiotics, fluids, diagnostic testing, mortality, and length of stay using random-effects models. Results: The interventions decreased time for the administration of antibiotics (mean difference [MD] ≈ 60 minutes; 95% CI: -75 to -45 minutes), fluids (MD ≈ 45 minutes; 95% CI: -60 to -30 minutes), and decreased time to collect blood cultures and obtain lactate measures. Importantly, these changes were associated with a 25% relative decrease in mortality (risk ratio 0.75; 95% CI: 0.65-0.85) and approximately three days less in the ICU, where in finally, we concluded Rapid recognition and management interventions, including sepsis alert systems and standardized bundles, substantially improve the timeliness of critical sepsis care elements in emergency settings, translating into significant mortality and morbidity benefits as well as These results support widespread implementation of timely sepsis protocols to enhance patient outcomes.