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Identify sepsis in patients by using early warning scores, doctors are urged

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h6237 (Published 24 November 2015) Cite this as: BMJ 2015;351:h6237
  1. Zosia Kmietowicz
  1. 1The BMJ

General practitioners and hospital doctors should all use an early warning score system when they suspect that a patient may have sepsis to help improve the recognition of cases, a report recommends.1

Nearly half (45%) of patients with sepsis admitted to hospital with no other obvious problem either died or were left with a disability, an audit of cases in England, Wales, and Northern Ireland has found.

A third (34%; 184) of the 544 hospitals reviewed had no formal sepsis protocol to identify and manage patients with sepsis, and this needs to be rectified, said a report into sepsis by the National Confidential Enquiry into Patient Outcome and Death.1

The inquiry reviewed the care of all patients who were seen by critical care teams in the community or admitted to hospital with a diagnosis of sepsis during two weeks in May 2014. Some 3363 patients were identified overall, 884 cases were selected for inclusion, and the case notes of 551 were examined. For the first time the inquiry also looked at events in general practice: 129 patients were seen by their GP, and the notes of 54 were reviewed.

An early warning scores system was used in none of the cases seen by GPs and in just 27% (128/479) of cases seen in secondary care. Of the 129 cases seen by a GP, only 34 patients (26%) had their temperature taken and 40 (31%) had their heart rate taken. In hospitals, 41% (152/369) of patients had a complete set of vital signs recorded.

Alex Goodwin, consultant in anaesthesia and intensive care medicine and an author of the report, said that as many as 200 000 cases of sepsis may occur in the United Kingdom each year, as well as 60 000 deaths. Cases are underestimated because the NHS prioritises the source of infection rather than sepsis for coding illnesses, he said.

“Sepsis has a number of faces,” said Goodwin. “In some cases it can be very obvious in patients who have low blood pressure, a high temperature, racing pulse or altered mental state. But it can also be present without any of these symptoms and is commonly mistaken for ‘flu’.

“This is why it can be so difficult to diagnose, and why recording a patient’s vital signs at all stages and documenting sepsis is so important. Identification of the condition across the healthcare system from primary care through to the emergency department and hospital wards must improve,” he said.

Vivek Srivastava, consultant in acute medicine and another of the report’s authors, said that the lack of awareness of sepsis and the reliance on senior hospital clinicians to diagnose it were a serious concern. When treated promptly, the first line interventions needed are simple, cheap, and readily available, he said.

“Taking a blood culture [and] giving antibiotics, oxygen and intravenous fluids require a fraction of the resources needed when compared with a hyperacute stroke unit, for example, and are well within the competence of junior doctors,” added Srivastava.

Notes

Cite this as: BMJ 2015;351:h6237

References

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