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Sepsis and rapid diagnostics


Early recognition and assessment can reduce the risk of sepsis death by 50%, and a rapid diagnosis that is safe, effective, efficient and person-centred is key to reliable rescue


Kevin D Rooney MBChB FRCA FFICM Consultant in Anaesthesia & Intensive Care Medicine and Professor of Care Improvement, Royal Alexandra Hospital; and University of the West of Scotland, Paisley, Scotland, UK


S


epsis is a life-threatening condition that arises when the body’s response to infection injures its own tissues and


With delays in treatment, sepsis can progress rapidly to septic shock, organ dysfunction and eventually death. Despite advances in modern medicine, antimicrobial agents and testing technology, sepsis remains one of


organs.1 the leading causes of mortality


worldwide. In the USA, there is an estimated of 751,000 cases of severe sepsis leading to over 215,000 deaths each year.2


In the UK,


sepsis kills approximately 37,000 people a year.3


The clinical signs and symptoms of sepsis, namely systemic inflammatory response criteria, are generally very vague and non- specific, making it difficult to identify patients with sepsis at an early stage and to treat them in a timely manner4


(Table 1).


Delays in sepsis recognition and treatment can have a profoundly negative effect on outcomes because for every hour’s delay in antibiotics in patients with septic shock,


mortality increases by 7.6%.5


The Ombudsman highlighted a number of recurring shortcomings in these patients’ care: namely a lack of necessary investigations, a failure to recognise the severity of the illness, delays in administering first-line treatment and a lack of timely critical care referral.


A recent report by the United Kingdom Parliamentary and Health Service Ombudsman reported the death of ten patients in the English National Health Service (NHS) due to poor initial assessment and delays in emergency treatment.6


This evidence base reinforces the practice of early and rapid recognition and treatment of patients with sepsis as a means to improving survival. Consequently, in order to minimise delays to treatment and maximise clinical benefit, any rapid diagnostic tool for sepsis identification must fulfil the Institute of Medicine six domains of quality healthcare and be safe, effective, efficient, equitable, timely and person-centred.7


Table 1: Systemic inflammatory response criteria Temperature Heart rate


Respiratory rate White cell count


Surviving Sepsis Campaign The Surviving Sepsis Campaign Guidelines 2012 has made some key recommendations concerning screening for sepsis, performance improvement and diagnosis.1 The guidelines advocate the routine screening of all potentially infected seriously ill patients for severe sepsis to allow earlier implementation of therapy.


To this end, the Royal College of Physicians developed a National Early Warning Score (NEWS), which is currently implemented in acute hospitals across the UK and has been successful in identifying patients at risk of deterioration or death.8,9 NEWS stratifies patients into risk categories based on observed heart rate, respiratory rate, systolic blood pressure, arterial oxygen saturation, temperature, and conscious level;


NEWS and screening Early intervention and response to deranged physiological parameters in the critically ill patient is crucial to improving survival outcomes.1


Greater than 38°C or less than 36°C Greater than 90 beats/min


Greater than 20 breaths/min, arterial carbon dioxide lower than 32mmHg or the need for mechanical ventilation


Greater than 1200/µl or less than 4000/µl or > 10% immature neutrophils


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