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Table 2 Outcomes throughout the intervention in the whole population and according to the success of the institutions

From: Implementation of sepsis bundles in public hospitals in Brazil: a prospective study with heterogeneous results

Variables Baseline
(n = 384)
Second quarter
(n = 288)
Third quarter
(n = 422)
Fourth quarter
(n = 531)
Fifth quarter
(n = 563)
Sixth quarter
(n = 492)
Seventh quarter
(n = 398)
Eighth quarter
(n = 357)
p Valuea
Hospital mortality
 All institutions 226 (58.9) 177 (61.5) 236 (55.9) 278 (52.4) 280 (49.7) 250 (50.8) 183 (46.0) 166 (46.5) <0.0001
 Successful institutions 113 (51.4) 71 (60.2) 122 (50.4) 103 (43.3) 117 (45.0) 78 (36.1) 77 (36.8) 114 (41.0) <0.0001
 Nonsuccessful institutions 113 (68.9) 106 (62.4) 114 (63.3) 175 (59.7) 163 (53.8) 172 (62.3) 106 (56.1) 52 (65.8)  
Hospital mortality: sepsis
 All institutions 85 (42.7) 76 (47.8) 108 (43.7) 155 (45.1) 125 (35.9) 118 (39.3) 97 (35.9) 85 (37.3) 0.028
 Successful institutions 36 (31.9) 35 (52.2) 56 (39.2) 60 (36.1) 64 (35.2) 33 (24.8) 43 (28.5) 64 (33.3) <0.0001
 Nonsuccessful institutions 49 (57.0) 41 (44.6) 52 (50.0) 95 (53.4) 61 (36.7) 85 (50.9) 54 (45.4) 21 (58.3)  
Hospital mortality: septic shock
 All institutions 141 (76.2) 101 (78.3) 128 (73.1) 123 (65.8) 155 (72.1) 132 (68.8) 86 (67.2) 81 (62.8) 0.0020
 Successful institutions 77 (72.0) 36 (70.6) 66 (66.7) 43 (59.7) 53 (67.9) 45 (54.2) 34 (58.6) 50 (58.1) <0.0001
 Nonsuccessful institutions 64 (82.1) 65 (83.3) 62 (81.6) 80 (69.6) 102 (74.5) 87 (79.8) 52 (74.3) 31 (72.1)  
Hospital mortality: ED
 All institutions 94/184 (51.1) 69/114 (60.5) 91/179 (50.8) 104/224 (46.4) 109/247 (44.1) 97/232 (41.8) 78/201 (38.8) 113/248 (45.6) 0.003
 Successful institutions 63/136 (46.3) 31/55 (56.4) 50/108 (46.3) 38/110 (34.5) 53/138 (38.4) 35/116 (30.2) 34/113 (30.1) 82/207 (39.6) <0.0001
 Nonsuccessful institutions 31/48 (64.6) 38/59 (64.4) 41/71 (57.7) 66/114 (57.9) 56/109 (51.4) 62/116 (53.4) 44/88 (50.0) 31/41 (75.6)  
Hospital mortality: wards
 All institutions 99/145 (68.3) 71/129 (55.0) 116/184 (63.0) 128/221 (57.9) 116/219 (53.0) 101/174 (58.0) 67/141 (47.5) 28/65 (43.1) 0.0001
 Successful institutions 29/48 (60.4) 26/42 (61.9) 54/91 (59.3) 41/77 (53.2) 33/67 (49.3) 15/47 (31.9) 22/60 (36.7) 11/35 (31.4) <0.0001
 Nonsuccessful institutions 70/97 (72.2) 45/87 (51.7) 62/93 (66.7) 87/144 (60.4) 83/152 (54.6) 86/127 (67.7) 45/81 (55.6) 17/30 (56.7)  
Hospital mortality: ICU
 All institutions 33/55 (60.0) 37/45 (82.2) 29/59 (49.2) 46/86 (53.5) 55/97 (56.7) 52/86 (60.5) 38/56 (67.9) 25/44 (56.8) 0.921
 Successful institutions 21/36 (58.3) 14/21 (66.7) 18/43 (41.9) 24/51 (47.1) 31/55 (56.4) 28/53 (52.8) 21/36 (58.3) 21/36 (58.3) 0.001
 Nonsuccessful institutions 12/19 (63.2) 23/24 (95.8) 11/16 (68.8) 22/35(62.9) 24/42 (57.1) 24/33 (72.7) 17/20 (85.0) 4/8 (50.0)  
Percentage of sepsis
 All institutions 199 (51.8) 159 (55.2) 247 (58.5) 344 (64.8) 348 (61.8) 300 (61.0) 270 (67.8) 228 (63.9) <0.0001
 Successful institutions 113 (51.4) 67 (56.8) 143 (59.1) 166 (69.7) 182 (70.0) 133 (61.6) 151 (72.2) 192 (69.1) <0.0001
 Nonsuccessful institutions 86 (52.4) 92 (54.1) 104 (57.8) 178 (60.8) 166 (54.8) 167 (60.5) 119 (63.0) 36 (45.6)  
Time to sepsis diagnosis, h
 All institutions 5.0 (1.5–17.0) 5.3 (1.5–19.5) 3.0 (0.9–10.9) 2.1 (0.9–7.7) 2.2 (0.8–8.7) 2.0 (0.7–6.8) 1.3 (0.6–4.0) 1.0 (0.4–2.1) <0.0001
 Successful institutions 5.7 (1.7–14.8) 5.2 (1.6–14.8) 2.6 (0.9–8.0) 1.7 (0.8–5.3) 2.0 (0.8–5.7) 1.1 (0.5–3.0) 1.0 (0.5–2.6) 0.8 (0.4–2.0) <0.0001
 Nonsuccessful institutions 4.0 (1.3–18.0) 6.3 (1.5–22.0) 4.7 (1.0–13.8) 3.5 (1.0–12.5) 2.9 (0.8–13.5) 3.7 (1.0–14.1) 2.5 (1.0–8.6) 2.0 (1.0–7.5)  
APACHE II score, points
 All institutions 23 (18–30) 23 (18–29) 20 (15–27) 19 (15–24) 18 (14–22) 18 (14–23) 17 (13–22) 17 (13–21) <0.0001
 Successful institutions 21 (17–28) 22 (18–29) 20 (15–25) 18 (14–23) 17 (13–21) 18 (14–22.2) 17 (12–21) 16.5 (13–21) <0.0001
 Nonsuccessful institutions 26 (20–31) 23 (18–28.8) 22 (15.5–28.5) 20 (15–26) 18 (14–22) 19 (14–23) 17 (13–22) 19 (15–23.5)  
SOFA score, points
 All institutions 8 (5–12) 8 (5–11) 7 (5–11) 7 (4–11) 7 (4–11) 7 (4–10) 6 (4–9) 6 (4–10) <0.0001
 Successful institutions 7 (4–11) 8 (5–11) 7 (4–10) 6 (3–9) 6 (3–10) 7 (4–10) 6 (3–9) 6 (3–9) <0.0001
 Nonsuccessful institutions 9 (6–12) 8 (5–11) 8 (5–12) 8 (5–11) 8 (5–12) 7 (5–11) 6 (4–9) 9 (6–12)  
Number of organ dysfunctions
 All institutions 2 (2–3) 2 (2–3) 2 (2–3) 2 (1–3) 2 (1–2) 2 (1–3) 2 (1–2) 2 (1–3) <0.0001
 Successful institutions 2 (2–3) 2 (2–3) 2 (2–3) 2 (1–3) 2 (1–2) 2 (1–2) 2 (1–2) 2 (1–2) <0.0001
 Nonsuccessful institutions 2 (2–3) 2 (2–3) 3 (2–3) 2 (2–3) 2 (1–3) 2 (1–3) 2 (1–3) 2 (2–3)  
Compliance with the first three itemsb
 All institutions 46 (12.0) 37 (12.8) 74 (17.5) 162 (30.5) 183 (32.5) 163 (33.1) 149 (37.4) 151 (42.3) <0.0001
 Successful institutions 21 (9.5) 11 (9.3) 37 (15.3) 70 (29.4) 77 (29.6) 72 (33.3) 70 (33.5) 102 (36.7) <0.0001
 Nonsuccessful institutions 25 (15.2) 26 (15.3) 37 (20.6) 92 (31.4) 106 (35.0) 91 (33.0) 79 (41.8) 49 (62.0)  
Full compliance with 6-h bundle
 All institutions 22 (5.7) 20 (6.9) 41 (9.7) 89 (16.8) 99 (17.6) 82 (16.7) 92 (23.1) 82 (23.0) <0.0001
 Successful institutions 10 (4.5) 8 (6.8) 25 (10.3) 41 (17.2) 37 (14.2) 33 (15.3) 44 (21.1) 59 (21.2) 0.016
 Nonsuccessful institutions 12 (7.3) 12 (7.1) 16 (8.9) 48 (16.4) 62 (20.5) 49 (17.8) 48 (25.4) 23 (29.1)  
Compliance with fluids and vasopressors
 All institutions 210 (60.9) 156 (62.2) 271 (76.6) 318 (75.2) 355 (79.1) 323 (81.4) 244 (82.7) 254 (91.0) <0.0001
 Successful institutions 125 (61.0) 55 (51.9) 164 (76.6) 150 (79.4) 164 (82.4) 138 (82.6) 139 (89.7) 203 (95.3) <0.0001
 Nonsuccessful institutions 85 (60.7) 101 (69.7) 107 (76.4) 168 (71.8) 191 (76.4) 185 (80.4) 105 (75.0) 51 (77.3)  
Compliance with antibiotics
 All institutions 218 (56.8) 164 (56.9) 271 (64.2) 358 (67.4) 386 (68.6) 347 (70.5) 274 (68.8) 263 (73.7) <0.0001
 Successful institutions 125 (56.8) 70 (59.3) 167 (69.0) 159 (66.8) 183 (70.4) 158 (73.1) 143 (68.4) 205 (73.7) 0.1072
 Nonsuccessful institutions 93 (56.7) 94 (55.3) 104 (57.8) 199 (67.9) 203(67.0) 189 (68.5) 131 (69.3) 58 (73.4)  
  1. APACHE II Acute Physiology and Chronic Health Evaluation II, ED Emergency department, ICU Intensive care unit, SOFA Sequential Organ Failure Assessment
  2. aGeneral linear models. The first p value refers to the comparison throughout the intervention; the second p value refers to the comparison between successful and nonsuccessful institutions
  3. bIncludes lactate sampling, blood cultures, and antibiotics in the first hour