Articles were eligible for inclusion if they evaluated human
patients with severe sepsis or
septic shock, reported timing of
antibiotic administration from
ED triage and/or septic shock/
severe sepsis recognition, and
reported mortality data. Studies involving nonhumans, those
involving patients less 18 years
old, and those focused solely
on neutropenic or immunocompromised subjects were
excluded. Review articles, editorials, case studies, and letters
to the editor were excluded,
although bibliographies were evaluated for relevant articles. Given an anticipated limited availability of high quality clinical trials evaluating our stated objective,
all study types, except those previously mentioned, were eligible
for inclusion. If the time to antibiotics or mortality was not explicitly reported, the study was potentially eligible for inclusion pend-ing author contact. The primary outcome was mortality.