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1-Hour Bundle – Flimsy Evidence for New “Standard of Care”

April 23, 2019

Written by Clay Smith

Spoon Feed
Evidence for the 1-hour bundle release by the Surviving Sepsis Campaign is weak. Yet, this is the new standard we are held to, despite ACEP, AAEM, and thousands of physicians, EM and non-EM alike, voicing concern that this is a very bad idea.

Why does this matter?
In April 2018, a 1-hour sepsis bundle was proposed. This is now a replacement and composite of the former 3 and 6 hour bundles. There was immediate backlash, which led to vigorous open debate and a seeming retraction by SCCM made jointly with ACEP. Despite this debate and continued opposition by ACEP and AAEM, the Surviving Sepsis Campaign has released an “updated” version of the 1-hour bundle that looks exactly the same except the start time is not ED triage but upon “recognition of sepsis.” The problem with the 1-hour bundle is that the evidence for this international guideline is retrospective in nature and may support one element, early antibiotics, but all other elements lack a solid evidentiary basis.

Here is a summary of the 1-hour bundle.

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From cited article

From cited article

Not a bundle of joy
Dr. Kalantari and Dr. Salim Rezaie (of REBEL EM) unpack the evidence for the 1h sepsis bundle.

The Surviving Sepsis Campaign has not rescinded its 1-hour bundle despite poor quality evidence to support it and a raft of physicians as well as two major EM organizations pointing out the serious problems with it. It is a mandate based on low quality evidence that will lead to practice change and possible harm and certainly unintended consequences. Once this is imposed as the standard, it can take years before we see the fallout and even longer to reverse new, bad habits.

Another Spoonful

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From cited article

From cited article

Source
Challenging the One-hour Sepsis Bundle. West J Emerg Med. 2019 Mar;20(2):185-190. doi: 10.5811/westjem.2018.11.39290. Epub 2019 Feb 4.

Open in Read by QxMD

Reviewed by Thomas Davis

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