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Tackling sepsis: new NICE clinical guidelines

On 13 July 2016 NICE (National Institute for Health and Care Excellence), the UK government’s healthcare advisory body published its first set of Guidelines on the diagnosis and management of sepsis.

The guidelines, titled “Sepsis: recognition, diagnosis and early management” is in response to a UK Parliamentary and Health Service Ombudsman Enquiry (2013) and a UK National Confidential Enquiry into Patient Outcome and Death (NCEPOD, 2015) that both highlighted sepsis as being a leading cause of avoidable death that kills more people than breast, bowel and prostate cancer combined, and my colleagues have written about this before, together with the widely reported tragic deaths of some young children from undiagnosed sepsis.

During the planning stages, the guideline committee identified that the key issues to be included were:

  • recognition and early assessment;
  • diagnostic and prognostic value of blood markers for sepsis;
  • initial treatment;
  • escalating care;
  • identifying the source of infection;
  • early monitoring;
  • information and support for patients and carers; and
  • training and education

What is sepsis?

Sepsis is a clinical syndrome caused by the body’s immune and coagulation systems being switched on by and then overreacting to an infection. If left untreated this overreaction can set off a cascade of other reactions in the body from shock, to organ failure and death.

The problem though is sepsis is difficult to diagnose with certainty. Whilst people with sepsis may have a history of infection, fever is not present in all cases and the signs and symptoms of sepsis can be very nonspecific, such as rapid breathing or feeling generally unwell. Furthermore the sepsis can be triggered from anywhere in the body where infection has occurred.

Could this be sepsis?

Because of these problems with diagnosis, sepsis can be missed and therefore, in the same way that healthcare professionals consider ‘could this pain be cardiac in origin?’ when presented with someone of any age with chest pain, this NICE Guideline aims to make ‘could this be sepsis?’ the first consideration for anyone presenting with a possible infection.

Detailed guidance is given about who is most at risk and what signs should trigger a suspicion of sepsis and then how best to manage the patient. The guidance is wide-reaching and covers primary care (GPs), secondary care (General District Hospitals) and tertiary care (specialist hospital units).

The Guidelines also then deal with aftercare and information for patients.

It is hoped that armed with this guidance between 5,000 and 13,000 deaths a year could be avoided through earlier referral by GPs and/or earlier treatment in hospitals.

Our experience

My colleagues and I in the Clinical Negligence Team regularly represent Claimant’s who have suffered injury (including death) from a failure to consider sepsis and treat it earlier. These cases involve Claimants of all ages from infection in new-borns and childhood meningitis through to cellulitis and peritonitis in adults and pneumonia in the elderly.

With the numbers of avoidable deaths from undiagnosed sepsis being so high, I hope that these recommendations will be widely adopted and lead to a substantial reduction in such deaths, and will be following this with interest.

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