Sepsis identification and bundle delivery in US emergency departments, 2012–2022: A nationally representative analysis
Authors' conclusion
Four-component bundle delivery increased modestly but remained incomplete, even among explicitly recognized sepsis patients.
Study context
- Population
- Adult emergency department (ED) visits with sepsis (explicit sepsis-specific code or implicit+ infection plus organ-dysfunction codes), US, 2012–2022
- Participants
- 820.1 million weighted adult ED visits
- Outcome
- Trends in sepsis identification and documented four-component bundle delivery (IV fluids, antibiotics, blood cultures, lactate)
Methodological detailsnationally representative survey (National Hospital Ambulatory Medical Care Survey (NHAMCS)), survey-weighted logistic and segmented regression
- Nationally representative survey (NHAMCS)
- Survey-weighted logistic and segmented regression
Main finding
As reported in the abstract
2012–2022
Visits meeting sepsis definition
18.3 million
2.2%
Sepsis identification rose from 0.9% to 2.5%; OR per year
1.14
99% CI 1.10–1.17
Bundle delivery rose from 2.4% to a peak of 20%; OR 1.15 per year
1.15
99% CI 1.07–1.23
2016 level shift in bundle delivery (OR)
4.38
Observational data: associations, not effects.
Further findings
Individual bundle components
- Lactate rose most steeply yet remained the least delivered
Factors associated with bundle delivery
- Severe presentation at triage (OR; 1.73-4.65)
- 2.84
- Abdominal infection source (OR; 0.12-0.72)
- 0.30
Original publication
Sepsis identification and bundle delivery in US emergency departments, 2012–2022: A nationally representative analysis. J Crit Care. Published 13 September 2026. doi:10.
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