| Title |
Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial
|
|---|---|
| Published in |
Intensive Care Medicine, May 2017
|
| DOI | 10.1007/s00134-017-4782-4 |
| Pubmed ID | |
| Authors |
Frank Bloos, Hendrik Rüddel, Daniel Thomas-Rüddel, Daniel Schwarzkopf, Christine Pausch, Stephan Harbarth, Torsten Schreiber, Matthias Gründling, John Marshall, Philipp Simon, Mitchell M. Levy, Manfred Weiss, Andreas Weyland, Herwig Gerlach, Tobias Schürholz, Christoph Engel, Claudia Matthäus-Krämer, Christian Scheer, Friedhelm Bach, Reimer Riessen, Bernhard Poidinger, Karin Dey, Norbert Weiler, Andreas Meier-Hellmann, Helene H. Häberle, Gabriele Wöbker, Udo X. Kaisers, Konrad Reinhart, for the MEDUSA study group |
| Abstract |
Guidelines recommend administering antibiotics within 1 h of sepsis recognition but this recommendation remains untested by randomized trials. This trial was set up to investigate whether survival is improved by reducing the time before initiation of antimicrobial therapy by means of a multifaceted intervention in compliance with guideline recommendations. The MEDUSA study, a prospective multicenter cluster-randomized trial, was conducted from July 2011 to July 2013 in 40 German hospitals. Hospitals were randomly allocated to receive conventional continuous medical education (CME) measures (control group) or multifaceted interventions including local quality improvement teams, educational outreach, audit, feedback, and reminders. We included 4183 patients with severe sepsis or septic shock in an intention-to-treat analysis comparing the multifaceted intervention (n = 2596) with conventional CME (n = 1587). The primary outcome was 28-day mortality. The 28-day mortality was 35.1% (883 of 2596 patients) in the intervention group and 26.7% (403 of 1587 patients; p = 0.01) in the control group. The intervention was not a risk factor for mortality, since this difference was present from the beginning of the study and remained unaffected by the intervention. Median time to antimicrobial therapy was 1.5 h (interquartile range 0.1-4.9 h) in the intervention group and 2.0 h (0.4-5.9 h; p = 0.41) in the control group. The risk of death increased by 2% per hour delay of antimicrobial therapy and 1% per hour delay of source control, independent of group assignment. Delay in antimicrobial therapy and source control was associated with increased mortality but the multifaceted approach was unable to change time to antimicrobial therapy in this setting and did not affect survival. |
X Demographics
The data shown below were collected from the profiles of 27 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 8 | 30% |
| Australia | 2 | 7% |
| United States | 1 | 4% |
| Malaysia | 1 | 4% |
| New Zealand | 1 | 4% |
| Venezuela, Bolivarian Republic of | 1 | 4% |
| Colombia | 1 | 4% |
| Saudi Arabia | 1 | 4% |
| Unknown | 11 | 41% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 23 | 85% |
| Practitioners (doctors, other healthcare professionals) | 2 | 7% |
| Scientists | 1 | 4% |
| Science communicators (journalists, bloggers, editors) | 1 | 4% |
Mendeley readers
The data shown below were compiled from readership statistics for 168 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 168 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Researcher | 23 | 14% |
| Student > Bachelor | 20 | 12% |
| Student > Master | 16 | 10% |
| Unspecified | 12 | 7% |
| Other | 8 | 5% |
| Other | 38 | 23% |
| Unknown | 51 | 30% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 56 | 33% |
| Nursing and Health Professions | 17 | 10% |
| Unspecified | 12 | 7% |
| Pharmacology, Toxicology and Pharmaceutical Science | 6 | 4% |
| Engineering | 4 | 2% |
| Other | 17 | 10% |
| Unknown | 56 | 33% |
Attention Score in Context
This research output has an Altmetric Attention Score of 27. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 August 2022.
All research outputs
#1,313,886
of 24,212,485 outputs
Outputs from Intensive Care Medicine
#1,178
of 5,217 outputs
Outputs of similar age
#26,468
of 314,695 outputs
Outputs of similar age from Intensive Care Medicine
#23
of 103 outputs
Altmetric has tracked 24,212,485 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 94th percentile: it's in the top 10% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 5,217 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 29.0. This one has done well, scoring higher than 77% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 314,695 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 91% of its contemporaries.
We're also able to compare this research output to 103 others from the same source and published within six weeks on either side of this one. This one has done well, scoring higher than 78% of its contemporaries.