Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Reflecting on sepsis: Definitions, new ideas, and a continued commitment to patient care

Steven Q. Simpson, MD
Conditions
September 19, 2016
Share
Tweet
Share

sepsis-blog-9-2016

CHEST_sig_horiz_PMS-TMSeptember is Sepsis Awareness Month, a month which aims to raise awareness of sepsis and strategies for prevention and treatment. Sepsis is a potentially life-threatening complication of an infection. Sepsis occurs when the body’s response to infection becomes dysregulated and white blood cells and chemicals cause injury to organs throughout the body.

Earlier this year, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine released a proposed new definition of sepsis and new diagnostic criteria for identifying sepsis. The new criteria rely on a change in Sequential Organ Failure Assessment (SOFA) with a score ≥ 2, or a modified “quick SOFA” for simpler use, while no longer focusing on the concept of the Systemic Inflammatory Response Syndrome (SIRS).

I argue this is a change we should not make. The criteria for initial detection of sepsis should not change, as recognition of SIRS allows for earlier detection and intervention, saving many more lives.

In the journal CHEST, I expressed opposition to adopting this new definition of sepsis and how it could cost patients lives, and I noted the concern from physicians of multiple specialties. Sepsis, which is associated with a high mortality rate, has variable clinical presentations and has few unifying pathophysiological features. Since the time of the original sepsis definitions conference in 1991, it is clear that the initial definitions of sepsis, severe sepsis, and septic shock, though imprecise, provide a useful framework for clinical intervention that, when used systematically, save lives.

The new criteria are based on sophisticated and well-executed retrospective analyses of very large patient databases. The authors sought to optimize the diagnosis of sepsis by determining which clinical signs were most predictive of mortality or an ICU stay of 3 or more days in spite of receiving treatment. On its face, this sounds like a good definition because we are obviously identifying really sick patients.  However, death and prolonged ICU stay are exactly the consequences that we hope to avoid by detecting sepsis earlier, when it is most treatable. If we adopt diagnostic criteria that are fine-tuned to predict the worst consequences of sepsis, then we will, in essence, be waiting until sepsis is more difficult to successfully treat, as the authors’ data show to be the case.

For over a decade, the current diagnostic criteria were mostly known and used by intensive care specialists. Only with the advent of the Surviving Sepsis Campaign were serious attempts made to train non-intensivists to recognize and aggressively treat severe sepsis. The campaign’s data show that regular use of the current diagnostic criteria, combined with evidence-based treatment, saves lives. I, and other like-minded sepsis experts, believe that the ubiquity and the lethal nature of sepsis demand that we approach any change in its clinical definition and diagnostic criteria with prospective studies that demonstrate improved outcomes for patients before attempting a wholesale change in our approach. Likewise, we believe that any modifications to our current diagnostic scheme should be aimed at earlier identification, not at improved specificity. There is no perfect diagnostic scheme for severe sepsis, and we will sometimes overdiagnose and sometimes underdiagnose. We must ask ourselves whether our patients should ever suffer the consequences of our failure to diagnose, when the consequences of diagnosing sepsis if the condition turns out not to be are so relatively benign.

Sepsis is complicated, and we’re all working to save lives and improve care. While my opinion hasn’t changed when it comes to the new criteria, I think Sepsis Awareness Month is a good opportunity to continue the conversation about the criteria change, raise awareness, and encourage our collective health-care community to continue to learn, understand, and rapidly identify cases of sepsis.

A few resources you might consider:

  • The CDC provides a great graphic on prevention of sepsis. I encourage you to share it on social media and within your own networks on how you can prevent sepsis. Join in the conversation on social with the #SepsisAwarenessMonth hashtag.
  • Are you up to date on research from the journal and other sources? During the month of September, the journal CHEST has made several important sepsis research articles free to view.
  • Sepsis Alliance is an organization whose purpose is to teach every American that sepsis is a medical emergency that needs aggressive treatment and to recognize its early symptoms. September is a great month to support that cause with $5 or $20 that you might otherwise spend on coffee.

Steven Q. Simpson is a pulmonologist.  He can be reached on Twitter @sqsimp.

Image credit: CDC

Prev

A hospital bullies a physician and threatens termination for her disability

September 19, 2016 Kevin 42
…
Next

If doctors wanted to be wealthy, they would have become UPS truck drivers

September 19, 2016 Kevin 22
…

Tagged as: Infectious Disease

Post navigation

< Previous Post
A hospital bullies a physician and threatens termination for her disability
Next Post >
If doctors wanted to be wealthy, they would have become UPS truck drivers

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Steven Q. Simpson, MD

  • Therapeutic temperature management takes a step up

    Steven Q. Simpson, MD

Related Posts

  • More physician responsibility for patient care

    Michael R. McGuire
  • The ultimate in patient empowerment: advance care planning

    Patricia McTiernan
  • Patient care is not a spectator sport

    Jim Sholler
  • Why health care fails to deliver better value in patient care

    Kristan Langdon, DNP and Timothy Lee, MPH
  • What Celine Dion can teach us about patient care

    Edward Leigh
  • A universal patient medical record

    Michael R. McGuire

More in Conditions

  • A speech pathologist’s key to better, safer patient care

    Adena Dacy, CCC-SLP
  • How collaboration saved my life from a rare disease doctors couldn’t diagnose

    Tami Burdick
  • Why your emotions are your greatest compass in therapy and life

    Maire Daugharty, MD
  • Patients are not waiting: What MCDA twin parents teach us about shared decision-making

    Stephanie Ernst
  • Health workers deserve care too: How to protect their mental health

    Corey Feist, JD, MBA & Kim Downey, PT
  • Why the words doctors use matter more than they think

    Erin Paterson
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician
    • A speech pathologist’s key to better, safer patient care

      Adena Dacy, CCC-SLP | Conditions
    • Navigating physician non-competes: a strategy for staying put [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician
    • A speech pathologist’s key to better, safer patient care

      Adena Dacy, CCC-SLP | Conditions
    • Navigating physician non-competes: a strategy for staying put [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...