The SEP-1 Sepsis Bundle Is Not Based on Evidence

The Centers for Medicare and Medicaid Services requires hospitals to report compliance with their SEP-1 sepsis bundle, yet there is concern that components of the bundle are not evidence-based and may result in harm (NEJM JW Emerg Med Sep 2018). To test whether certain elements of SEP-1 are supported by evidence, these authors performed a systematic review and meta-analysis of studies comparing mortality between patients treated with sepsis bundles that included antibiotics and fluid administration and patients treated without a bundle.

Seventeen observational studies were included. Risk of bias was moderate to high. Use of bundles was associated with increased odds of survival (pooled odds ratios, 1.2, 2.0, and 1.3 in the largest, middle-si…