White Coat, Black Art·DR. GOLDMAN'S BLOG

Early detection could avert the dangers of sepsis

When it comes to diagnosing life-threatening sepsis, minutes count. A new way to help doctors clue in to the deadly diagnosis could save lives.
Vital signs like blood pressure and temperature could be used to detect sepsis faster. (Jake Costello/CBC)

Sepsis is a major cause of death in hospitals. That is especially so when the diagnosis is delayed. A study just published in the Canadian Medical Association Journal shows how to speed up the diagnosis.

Researchers in the United Kingdom used a scoring system called the National Early Warning Score or NEWS score to aid in the early detection of sepsis. The NEWS score is derived using vital signs such as blood pressure, temperature and level of consciousness that are collected routinely by nurses. It was tested on all patients 16 years of age and older who were admitted on an emergency basis to several hospitals in England over two years.

The researchers found that a computer-aided version of the NEWS score enhanced doctors' ability to predict which patients would get sepsis. As well, the system triggered screening for sepsis usually within 30 minutes of the patient's admission to hospital provided the vital signs collected by nurses were entered electronically into the patient's health record.

Sepsis is defined as the body's overwhelming and life-threatening response to infection. It damages organs such as the heart, the lungs and the kidneys and leads to organ failure, and death. Sepsis causes 25,000 deaths per year in Canada, making it the 12th leading cause of death. Many patients diagnosed with sepsis require care in the intensive care unit, which is expensive. The total cost of treating sepsis in Canada amounts to an estimated $325 million annually, the Canadian Sepsis Foundation said on its website.

The key to survival is rapid diagnosis. Studies have shown that every hour of delay in diagnosing sepsis reduces the chance of survival by seven per cent, which is what led to the study published on Monday in CMAJ.

A physician works inside an intensive unit care in Buenos Aires in 2014. Many patients diagnosed with sepsis require care in the intensive care unit, which is expensive. (Enrique Marcarian/Reuters)

The National Early Warning Score is far from perfect. It was designed to make use of vital signs that are readily available because nurses record them in real time. A more accurate sepsis score might include blood tests, but these take time to do the test and obtain the results. One quarter of patients with sepsis do not have blood tests done within the first 24 hours of hospital admission.

Point-of care blood testing could speed that up especially if the testing can be done through the skin using a device that generates a vacuum that enables a small sample of blood to be drawn from tiny open channels into a small tube through a process known as capillary action. That sort of technology is being used currently to measure blood sugar without the use of needles.

The Surviving Sepsis Campaign (SSC) is a joint effort aimed at reducing mortality and morbidity or disease from sepsis and septic shock worldwide. The idea behind the campaign is to teach health professionals how to recognize and screen patients for sepsis within the first hour of arriving at the hospital since early intervention can make all the difference in prevention of organ failure and death. 

Greater vulnerability to sepsis

It helps doctors to identify which patients are at increased risk. That includes older adults, infants under one year of age and pregnant women. So are people with chronic conditions such as diabetes, heart failure, chronic obstructive pulmonary disease, kidney disease and cancer. The more chronic conditions the patient has, the greater the risk. People with weakened immune systems are also at increased risk. That includes patients with HIV, patients who take anti-rejection drugs and those who take biologic drugs for diseases like colitis and rheumatoid arthritis. People who have severe wounds including burns are also at risk.

Overall, the vulnerability to sepsis is greater these days because there are more opportunities for infections to become complicated. For instance, more people are having invasive procedures and organ transplants, and more are taking medications that suppress the immune system. Rising resistance to antibiotics is another factor.

It's important for health professionals and patients to be aware of the symptoms of sepsis. Usually, it starts with a recognizable infection such as pneumonia or a wound infection. I'd be very concerned about patients who have a high fever, rapid heart or breathing rate and unusual sweating. The indications of sepsis can be subtle and include dizziness or feeling lightheaded, confusion or any other unusual change in mental state, including a feeling of impending doom, slurred speech, diarrhea, nausea and vomiting, severe muscle pain and extreme general discomfort, difficulty breathing, decreased urination, skin that is cold, clammy, and pale, or discoloured or mottled, and loss of consciousness.

Patients should not attempt to make a diagnosis on their own from home. They should get medical help as soon as possible.

ABOUT THE AUTHOR

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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