Rory's Regulations: Association Between the New York Sepsis Care Mandate and In-Hospital Mortality for Pediatric Sepsis
In 2012, Rory Staunton, a 12-year-old from New York City, tragically died after developing sepsis from a seemingly innocent scrape to his arm during basketball practice. Many believe his death could have been prevented if his case of sepsis had been recognized and treated earlier.
His parents, Orlaith and Ciaran Staunton, turned their grief into action, founding the Rory Staunton Foundation for Sepsis Prevention.
In 2013, New York State issued a statewide mandate for all hospitals to develop protocols for sepsis recognition and treatment, dubbed ‘Rory’s Regulations’.
In April 2017, the New York Times featured an article with data from the New York State Department of Health, saying that Rory’s Regulations have saved close to 5,000 New Yorkers so far. However, this analysis looked at adult patients with sepsis.
Now, researchers have analyzed how children with sepsis fared in hospitals in New York State. The study, published this Tuesday in the Journal of the American Medical Association (JAMA), found that children who had received recommended treatment within 60 minutes were more likely to survive the medical emergency known as sepsis. According to the study, which included 1,200 New York State children, completion of the sepsis protocol within one hour was associated with nearly one-third lower risk of death. The effect of completing any given part of the protocol within an hour – for example, giving fluids but not testing for infection or giving antibiotics – did not significantly change the risk of death, the researchers noted, suggesting the greatest benefit comes from accomplishing the entire bundle quickly.
The study has its limitations. In particular, sepsis had to be recognized to even get into the dataset – although recognition of sepsis in the first place might be more important than the rapid treatment of sepsis when it is recognized. It’s also possible that the patients who were treated faster were already more likely to survive - maybe that’s what it made it easier for doctors and nurses to diagnose their sepsis earlier.
Nevertheless, this study is incredibly encouraging. It adds to a growing number of studies finding that early sepsis treatment is beneficial, and importantly extends these findings to children. It is widely accepted that rapid sepsis recognition and treatment saves lives, and after all, no child should die from a treatable infection.