Kids are more likely to survive when clinicians quickly follow three crucial steps.
by Lisa Esposito, Staff Writer.
First Published U.S. News, Wednesday, July 25, 2018
Take blood cultures. Start antibiotics. Give intravenous fluid. Following these three standard hospital procedures within an hour can save the life of a child with sepsis, a new study suggests.
Researchers analyzed how kids with severe sepsis fared in hospitals in New York state, where “Rory’s Regulations” – named after a boy who died of sepsis when the health care system failed him – are now mandated. The study, released Tuesday in JAMA, found that children who had received recommended treatment within 60 minutes were more likely to survive the life-shattering complication of sepsis.
Sepsis is a body-wide complication resulting from an infection. In an effort to combat the infection, the body overreacts by releasing chemicals into the bloodstream that provoke widespread inflammation. The cascade of resulting changes can lead to multiple organ failure, plunging blood pressure and death if sepsis advances to severe sepsis and septic shock. Among people who survive advanced sepsis, some require amputations of their fingers, toes or limbs.
Behind every sepsis mortality statistic is a child whose death might have been prevented and parents who will forever agonize over what could have been done differently.
Pediatric protocols in New York hospitals statewide spell out the three evidence-based steps that clinicians must promptly take for a child with possible sepsis. After the protocols were put in place, the researchers evaluated findings from pediatric patients treated in emergency rooms, hospital inpatient units and intensive care units statewide, from mid-2014 through 2016. The study included nearly 1,200 patients younger than 18 who were placed on the sepsis protocol.
The key point of comparison was whether children completed the sepsis “bundle” of treatments within one hour or not. With the bundle, clinicians take blood cultures, start kids on broad-spectrum antibiotics and infuse a weight-based dose of intravenous fluids in that period.
Kids with sepsis who received all three treatment measures were more likely to survive than those who received a single bundle element in the one-hour window. Completing the sepsis bundle within 60 minutes was tied to 40 percent lower odds of children dying of sepsis.
“These were children that were being cared for both at specialty children’s hospitals as well as adult hospitals that take care of kids,” says Dr. Christopher Seymour, the senior study author. “The clinicians in the study, the nurses and doctors, were challenged to deliver care for patients that they might not see as much as others,” says Seymour, who is an associate professor of critical care and emergency medicine at the University of Pittsburgh School of Medicine.
Awareness of sepsis in both adults and children, and understanding how sepsis might show up differently in kids, is the first step toward improving these results, Seymour says. “Once clinicians are aware of the signs and symptoms, having a structured set of steps for those first few hours is one way to get guideline-recommended treatments given to patients as often as possible.”
Ciaran and Orlaith Staunton are gratified by the new study findings. The couple’s tireless efforts were instrumental in the effort to mandate pediatric sepsis protocols in New York hospitals. It was their son, Rory Staunton, who inspired the pioneering regulations.
“It’s incredibly encouraging,” Ciaran Staunton says. “It comes too late for our son but it means someone else’s son will be spared this horrendous tragedy.”
Hospitalized patients in intensive care have a higher risk for developing sepsis. However, community-acquired sepsis accounts for the majority of severe sepsis hospitalizations – nearly 63 percent – compared with 26 percent health care-associated cases (such as in nursing homes) and 12 percent hospital-acquired cases, researchers found in a nationally representative analysis of 2012 hospital discharge figures.
Overall, more than 1.5 million people develop sepsis each year, according to U.S. figures. Among children, premature babies and infants are most vulnerable, according to the Sepsis Alliance. Nationwide, more than 75,000 children develop severe sepsis yearly, and nearly 7,000 of these kids die.
Sepsis can occur in a healthy child or adult starting even with a skin infection. That’s what happened to 12-year-old Rory, who cut his arm while diving for a ball during gym class at his New York school. The seemingly minor mishap turned into a systemic blood infection. A few days later, on April 1, 2012, Rory died in a tragic set of circumstances.
Rory’s devastating story is a chronicle of sepsis symptoms missed by health care providers and lost opportunities to start lifesaving treatment. Since then, the Rory Staunton Foundation’s mission has been working to raise sepsis awareness and improve pediatric medical procedures around sepsis in hospital emergency rooms.
In January 2013, Gov. Andrew Cuomo announced the adoption of “Rory’s Regulations” in New York hospitals statewide. “The first hour is critical,” Ciaran Staunton says. “When we see how many children can be saved, it should be compulsory in every state.” In 2016, Illinois also mandated that sepsis protocols be implemented in hospitals statewide. In January, New Jersey adopted a similar rule.
The Rory Staunton Foundation keeps working to beat sepsis. That includes promoting K-12 sepsis education and launching the National Family Council on Sepsis. Orlaith Staunton has contributed to the Safe Healthcare blog hosted by the Centers for Disease Control and Prevention.
Along with advocacy, the Stauntons stay busy with family matters. “Kathleen, our daughter, is entering her last year of high school,” Ciaran Staunton says. “And Rory; well, he would be 19 years old and at college. He would have graduated high school last year.”
According to health agencies like the CDC, symptoms such as these, alone or in combination, should trigger doctors and nurses to consider sepsis:
- Fever and shivering occur as the body reacts to the infection. Patients may complain of feeling cold.
- Pale or mottled skin is another sepsis indication.
- Patients can become confused and their mental status may change as sepsis affects the brain.
- Rapid breathing can be a result of lactic acid levels rising in the blood due to sepsis.
- Quickened heart rate or falling blood pressure are other vital sign changes related to sepsis. Patients may feel dizzy or lightheaded, and even pass out.
- Low urine output and changes in urine lab tests may indicate failing kidneys from sepsis.
- Abdominal pain is another sign that severe sepsis is affecting organ function.
“The [study] data suggests to parents to be mindful of the signs of severe infection. In particular, this is about thinking about keeping simple cuts and bruises clean,” Seymour says. When a child is not acting like his or her usual self; when there’s high fever, confusion or the child’s not eating, he says, “these are warning signs in which parents should use the words ‘severe infection’ or sepsis when talking to the doctor.”
Sepsis is much more common in adults, notes Dr. Martin Doerfler, the associate chief medical officer at Northwell Health, a large hospital system based in Hyde Park, New York. More research is available for adult sepsis, including a study he did with about 15,000 patients, published in the March 2017 issue of Critical Care Medicine.
With adult sepsis bundles, the target is for treatment within three hours. “When you look at the timing of antibiotics, in particular, every hour that you delay, you statistically get an increase in mortality for the population you have in that group,” Doerfler says. By adhering to sepsis protocols, he says, the health system reduced death rates for severe sepsis in adults by almost two-thirds.
Age-specific pediatric sepsis protocols are embedded at Cohen Children’s Medical Center, part of the Northwell system, Doerfler says. “Sepsis in a 6-month-old is very different than sepsis in a 16-year-old, both in its presentation and in some of the elements in how you treat it,” says Doerfler, who serves on the Rory Staunton Foundation’s medical advisory board.
Awareness is growing, Doerfler says, with clinicians more likely to quickly recognize signs and symptoms of sepsis in patients coming into the emergency room. However, he adds, it might still behoove family members to speak up.
“If you look at the Stauntons’ own circumstance, the pediatrician that they were with in the community did not think of [sepsis],” Doerfler says. “And when they went to a busy, highly regarded academic emergency department, that individual looked at the referral from the pediatrician who thought Rory had a viral enteritis and all of his symptoms were related to a different problem, and gave him fluid but didn’t think to give the antibiotics.”
In some cases, Doerfler suggests, a family member coming in and saying, “I’m concerned about sepsis,” could trigger a clinician to consider the possibility sooner and begin more aggressive treatment, and in doing so, cut through the dangerous delay.
To read this article on U.S. News, please click here.
Orlaith Staunton, co-founder of the Rory Staunton Foundation for Sepsis Prevention, and her daughter looked at each other in disbelief. They felt they were watching history repeat itself as a basketball coach bandaged a cut for one of his players, but without taking the precaution of cleaning the wound beforehand. That was the same scenario they believe led to sepsis and ultimately the death of Orlaith’s son Rory.
In a new post on CDC’s Safe Healthcare Blog, Orlaith explains the Rory Staunton Foundation’s back to basics approach to prevent infections that could lead to sepsis. Since one of the back to basics principles is the importance of hand washing, this message is particularly timely as we mark World Hand Hygiene day on May 5.
Read Orlaith’s blog about the Foundation’s back to basics approach to infection prevention, sepsis, our family and our work to prevent infections and sepsis on CDC’s Safe Healthcare Blog.
The tragic death of a 12-year-old boy has led a grieving family to educate others on the issue of sepsis — one of the leading causes of death in the U.S.
To read the original article on People.com, please click here.
The Rory Staunton Foundation for Sepsis Prevention applauds passage of ‘Rory Staunton’s Law’, which makes New York State the first in the nation to provide comprehensive K-12 sepsis education for every child.
NEW YORK (PRWEB)November 06, 2017
Governor Andrew Cuomo has signed Rory Staunton’s Law (Bill A6053A). The bill directs the commissioner of education to collaborate with the department of health and other health organizations to establish regulations for sepsis awareness and prevention programs for school districts, boards of cooperative educational services and non public schools in New York State. New York is the first state in the nation to provide sepsis modules, free of charge, to every school. Governor Cuomo has a history of supporting policies to combat sepsis: In 2013, he signed Rory’s Regulations into law, requiring all hospitals to adopt evidence-based sepsis protocols. These protocols have saved more than 5,000 New York lives.
The Rory Staunton Foundation for Sepsis Prevention (https://rorystauntonfoundationforsepsis.org), in collaboration with the New York Departments of Health and Education and the American Federation of Teachers (AFT), has produced the sepsis curriculum. It promotes a ‘back to basics’ approach to preventing infection, educates students about the risks and signs of sepsis and encourages young people educate others in the community about infection and sepsis by devising public health awareness campaigns. The lessons and associated resources are available through the Rory Staunton Foundation website, the New York State Department of Education site, and on the American Federation of Teachers award-winning Share My Lesson Platform, which is utilized by more than 1.2 million teachers nationwide. In addition to lesson plans, the curriculum includes tools to engage students, parents and teachers, including a read-along picture book for young children (Ouch! I Got a Cut!) and an animated two-minute video about the dangers and signs of sepsis (Sepsis: What You Need to Know to Save a Life, available at https://youtu.be/7f_FxKGEk4E).
This Bill was introduced in the New York Assembly by Assemblywoman Catherine Nolan of Queens. “It has been a great honor to work with the Staunton family on developing this legislation on sepsis awareness and education,” said Assemblywoman Nolan. “Rory Staunton was a wonderful young man who was taken from us by a deadly infection. His parents have bravely dedicated themselves to making changes and educating others to save lives. I want to thank Governor Cuomo for signing Rory Staunton’s law. The work of the Staunton family will save lives and insure that Rory Staunton will always be remembered.”
The Rory Staunton Foundation was established by Ciaran and Orlaith Staunton, whose 12-year-old son, Rory, lost his life to sepsis in 2012. Rory fell and grazed his arm at his school in Queens, New York, and died four days later from undiagnosed, untreated sepsis. “We are immensely proud and grateful that, at last, every child in New York State will have the tools and knowledge they need to protect themselves and their loved ones from sepsis,” said Ciaran and Orlaith Staunton. “Once again, New York State has led the way in providing pragmatic solutions for defeating sepsis, a condition that shatters families like our own on a daily basis.”
Sepsis, a potentially fatal condition stemming from infection, claims more lives in the United States than AIDS, breast and prostate cancers, and stroke combined and costs the U.S. healthcare system $24 billion per year, according the American Medical Association. Yet sepsis is unknown to most Americans. This lack of awareness is partly responsible for the catastrophic death toll as rapid diagnosis followed by antibiotics are essential to survival.
About the Rory Staunton Foundation
The Rory Staunton Foundation was established by Ciaran and Orlaith Staunton following the preventable death of their 12-year-old son, Rory, from sepsis in 2012. The Foundation is dedicated to improving the recognition and treatment of sepsis through public education and improved hospital protocols. Sepsis is the leading cause of death for infants and children worldwide.
Thank you, Governor Cuomo and Assemblywoman Cathy Nolan. A new Bill has passed the legislature in New York State and been signed by the Governor to ensure that all New York State children learn about sepsis in their schools.
BILL NO. A06053A also known as “Rory’s Staunton’s Law,” “Directs the commissioner of education to collaborate with the department of health and other health organizations to establish regulations for a sepsis awareness and prevention program for school districts, boards of cooperative educational services and nonpublic school.”
After a three-year campaign by residents, including sepsis survivor Nicole Taylor and her family, and the Rory Staunton Foundation, New Jersey Mandatory Sepsis Protocols Should Make Their Way to ALL New Jersey hospitals!
But we’re not there yet…
Public comment on the proposed rule change has closed and thank you all for referencing our advice!
“I want mandatory, life-saving sepsis protocols in New Jersey hospitals!” “Proposed New Rule: N.J.A.C. 8:43G-14.9/Hospital Licensing Standards – Infection Control: Sepsis Protocols”
…Yes, there are hospitals in NJ that have sepsis protocols in place, but not every hospital. …what if you or your loved ones go to a hospital that doesn’t follow sepsis protocols?
We can NOT allow “choosing the right hospital” to determine life or death with regards to sepsis!
We appreciate the work of Commissioner Bennett and hope that you encourage her to implement these protocols immediately to start saving lives. ALL New Jersey residents deserve life-saving sepsis protocols in ALL hospitals – NOW!
Join us in making New Jersey SAFE FROM SEPSIS!
Rory is making history again – New York Schools will teach back-to-basics education for treating wounds, will educate regarding infection and teach lifesaving lessons about sepsis.
Read the New York State Education Department press release here.
August 1, 2017, the Rory Staunton Foundation and the Patient Safety Movement Foundation joined forces in Vermont to discuss the implementation of mandatory sepsis protocols.
Rory Staunton Foundation Co-Founder, Ciaran Staunton, and Regional Chairs/Volunteers Mari Miceli and Georgi D’Alessandro of the Patient Safety Movement Foundation met with Vermont Commissioner of Health, Dr. Mark Levine, and the Vermont State Epidemiologist for Infectious Disease, Dr. Patsy Tassler Kelso, to urge the implementation of Rory’s Regulations in all Vermont hospitals.
In May 2017, the New England Journal of Medicine (NEJM) confirmed that Rory’s Regulations in New York State hospitals are saving lives. We thank the Commissioner and Dr. Patsy Tassler Kelso for their attention to this urgent health issue and look forward to helping Vermont become the next “sepsis safe” state.
By Jayne O’Donnell
Published by USA Today, May 22, 2017
New York regulations named after a 12-year-old victim of sepsis increased the chance of survival from the potentially deadly condition, a study out Sunday shows.
“Rory’s Regulations,” named for the late Rory Staunton of New York City, requires hospitals to quickly perform a checklist of safety measures when people show up at hospitals with sepsis. A report in the New England Journal of Medicine Sunday found the faster hospitals completed the checklist of care and administered antibiotics, the lower the risk of death in hospitals from sepsis. With each additional hour it took, the risk of death increased 4%.
Sepsis, which occurs when the body’s response to an infection injures its own tissues and organs, is the biggest killer of hospital patients. More than 1.5 million cases of sepsis occur in the U.S. annually and more than 20% of people who contract sepsis die from it.
Rory Staunton died five days after falling and getting a cut on his arm in his school gym.
“This is an amazing policy that happened,” says University of Pittsburgh medical school assistant professor and physician Chris Seymour, lead author on the study.
“Minutes matter, and it is critical to perform the correct tests and get the patient antibiotics as fast as possible,” said co-author Mitchell Levy, a physician and professor at Brown University’s medical school.
Ciaran Staunton, Rory’s father, says he seldom uses this word but calls the findings “huge.”
“I have met a lot of the families saved in New York because they had to rule out sepsis,” says Staunton. “I’ve been to the grave sites in other states where there were no protocols.”
Read the original story on USA Today here.
WASHINGTON — Minutes matter when it comes to treating sepsis, the killer condition that most Americans probably have never heard of, and new research shows it’s time they learn.
Sepsis is the body’s out-of-control reaction to an infection. By the time patients realize they’re in trouble, their organs could be shutting down.
New York became the first state to require that hospitals follow aggressive steps when they suspect sepsis is brewing. Researchers examined patients treated there in the past two years and reported Sunday that faster care really is better.
Every additional hour it takes to give antibiotics and perform other key steps increases the odds of death by 4 percent, according to the study reported at an American Thoracic Society meeting and in the New England Journal of Medicine.
That’s not just news for doctors or for other states considering similar rules. Patients also have to reach the hospital in time.
“Know when to ask for help,” said Dr. Christopher Seymour, a critical care specialist at the University of Pittsburgh School of Medicine who led the study. “If they’re not aware of sepsis or know they need help, we can’t save lives.”
The U.S. Centers for Disease Control and Prevention last year began a major campaign to teach people that while sepsis starts with vague symptoms, it’s a medical emergency.
To make sure the doctor doesn’t overlook the possibility, “Ask, ‘Could this be sepsis?'” advised the CDC’s Dr. Lauren Epstein.
Once misleadingly called blood poisoning or a bloodstream infection, sepsis occurs when the body goes into overdrive while fighting an infection, injuring its own tissue. The cascade of inflammation and other damage can lead to shock, amputations, organ failure or death.
It strikes more than 1.5 million people in the United States a year and kills more than 250,000.
Even a minor infection can be the trigger. A recent CDC study found nearly 80 percent of sepsis cases began outside of the hospital, not in patients already hospitalized because they were super-sick or recovering from surgery.
In addition to symptoms of infection, worrisome signs can include shivering, a fever or feeling very cold; clammy or sweaty skin; confusion or disorientation; a rapid heartbeat or pulse; confusion or disorientation; shortness of breath; or simply extreme pain or discomfort.
If you think you have an infection that’s getting worse, seek care immediately, Epstein said.
Doctors have long known that rapidly treating sepsis is important. But there’s been debate over how fast. New York mandated in 2013 that hospitals follow “protocols,” or checklists, of certain steps within three hours, including performing a blood test for infection, checking blood levels of a sepsis marker called lactate, and beginning antibiotics.
Do the steps make a difference? Seymour’s team examined records of nearly 50,000 patients treated at New York hospitals over two years. About 8 in 10 hospitals met the three-hour deadline; some got them done in about an hour. Having those three main steps performed faster was better — a finding that families could use in asking what care a loved one is receiving for suspected sepsis.
Sepsis is most common among people 65 and older, babies, and people with chronic health problems.
But even healthy people can get sepsis, even from minor infections. New York’s rules, known as “Rory’s Regulations,” were enacted after the death of a healthy 12-year-old, Rory Staunton, whose sepsis stemmed from an infected scrape and was initially dismissed by one hospital as a virus.
Illinois last year enacted a similar sepsis mandate. Hospitals in other states, including Ohio and Wisconsin, have formed sepsis care collaborations. Nationally, hospitals are supposed to report to Medicare certain sepsis care steps. In New York, Rory’s parents set up a foundation to push for standard sepsis care in all states.
“Every family or loved one who goes into a hospital, no matter what state, needs to know it’s not the luck of the draw” whether they’ll receive evidence-based care, said Rory’s father, Ciaran Staunton.