David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
Wesorick DH, Chopra V. Annals for Hospitalists - 18 October 2016. Ann Intern Med. 2016;165:HO1. doi: 10.7326/AFHO201610180
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Published: Ann Intern Med. 2016;165(8):HO1.
Studies that evaluate prognostic accuracy are limited by clinical heterogeneity and inadequate methodological quality.
None of the included studies directly assess the influence of these models on patient management and outcomes, or their cost-effectiveness.
Based on existing evidence, it is difficult to make recommendations about the practical clinical use of these scores, and the authors suggest that this area is ripe for additional research.
The mandatory reporting on these bundles is hampered by the lack of a widely agreed-on definition of sepsis.
Although the CMS bundle still uses systemic inflammatory response (SIRS) criteria, the recent Sepsis-3 Consensus Conference has conceptually reframed sepsis, and has abandoned the use of SIRS in sepsis.
The bundle is based on the concept of goal-directed therapy, but at least 3 trials over the past 2 years have found no benefit with this approach.
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