Paramedics and A&E doctors almost never suspect sepsis and two of the four ways health professionals screen for the killer condition do not work, according to research presented at the European Emergency Medicine Congress yesterday in Barcelona.
Sepsis, often referred to as blood poisoning, is a life-threatening condition that arises when the body’s immune system goes into overdrive in response to an infection and injures the body’s tissues and organs. It is vital to recognise it early, otherwise it can lead to shock, multiple organ failure and even death.
Health scientist Silke Piedmont, from the Department of Emergency Medicine Campus Benjamin Franklin Charité – Universitätsmedizin Berlin (Germany), and her colleagues from the University of Magdeburg and Jena (Germany), analysed data on 221 429 patients who were seen by emergency medical services (EMS) in Germany in 2016 outside the hospital setting.
They said they uncovered significant flaws in two of the four screening tools used by health workers worldwide to identify cases of the life-threatening illness.
The four systems are NEWS2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome).
They found that only one out of four screening tools had a reasonably accurate prediction rate for sepsis – NEWS-2 (National Early Warning Score). It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic cases.
A second screening tool, qSOFA (quick Sequential Organ Failure Assessment), correctly predicted 96.6% of patients who did not have sepsis.
Piedmont said: “We found that paramedics never documented a suspicion of sepsis, and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases. The screening tools recommended in the Surviving Sepsis Campaign guidelines differed greatly in terms of which and how many patients were identified as possibly having sepsis.”
Sepsis is estimated to be involved in the deaths of about 48 000 people a year in the UK, reports The Guardian.
Doctors, NHS bosses and health charities have been concerned for years that too many cases go undiagnosed, leaving people badly damaged or dead, because sepsis is so hard to detect.
Health workers are much more likely to correctly identify the signs of a heart attack or stroke, which means those patients have a greater chance of survival.
Problems in spotting sepsis meant that 31.4% of sepsis patients in the study died within 30 days, compared with 13.4% of those who had had a heart attack and 11.8% of stroke sufferers, said Dr Wolfgang Bauer, a co-author.
“In emergency care, there are good and long-established standards for the detection and treatment of heart attacks and stroke that have improved patients’ chances of survival. Unfortunately, a lot less attention is paid to sepsis and standards to improve early sepsis recognition and survival.
“Our study found there was a similar incidence for sepsis, 1.6%, as for heart attacks, 2.6%, and stroke, 2.7%, in cases seen by emergency medical services. However, in terms of both percentages and absolute numbers, more patients died from sepsis than from heart attacks or stroke.
“Out of all cases with sepsis, 31.4% died within 30 days after being seen by emergency services, versus 13.4% and 11.8% respectively for heart attacks and stroke. These findings emphasise the need for better sepsis awareness and more frequent use of effective screening tools.”
The findings, which have not been peer-reviewed and are described as “observational”.
Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said: “Sepsis continues to be fiendishly difficult to diagnose in the early stages. The problem is that the early symptoms are often similar to less serious conditions.
“To reduce the risk of missing this potentially devastating diagnoses, we recommend early assessment by a trained clinician and routine use of early warning scores such as NEWS2.”
Surviving Sepsis Guidelines (Open access)
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CDC issues new guidelines on sepsis management
$3m funding for UK-biotech to develop a rapid diagnostic for sepsis
WHO report on global epidemiology and the burden of sepsis — 1 in 5 deaths
Sepsis associated with 1 in 5 deaths globally, double previous estimate