Sepsis is in the news again following new guidance from the National Institute of Health and Care Excellence (NICE) urging doctors to be vigilant to the possibility of sepsis in patients, and to consider it as a potential diagnosis as early as possible.
Sepsis is a complex and potentially life threatening condition which causes 44,000 deaths in the UK every year. That’s more than bowel cancer, prostate cancer and breast cancer deaths combined. Experts believe that up to 13,000 of these could be avoided by spotting and treating the condition earlier.
What is sepsis?
Sepsis is a condition whereby the body’s immune system goes into overdrive as it tries to fight infection, causing damage to its own tissues and organs. If not treated early enough, sepsis can lead to septic shock, multiple organ failure and even death.
Sepsis can be caused by many different types of bacteria, originating in any part of the body. The most common sites of infection are the abdomen, lungs, urinary tract and pelvis but it can develop from something as simple and minor as a cut finger or a graze. Those with a weakened immune system and the very old and young are especially vulnerable.
Early signs of sepsis can include a high or low body temperature, a fast heartbeat, fast breathing, chills and shivering. These non-specific symptoms mean that it can be difficult to distinguish sepsis from flu or other minor illnesses. Doctors are also under increased pressure to avoid over-prescribing antibiotics for viral infections, meaning they may miss the opportunity to prescribe treatment early on.
When sepsis becomes more serious, sufferers can develop breathlessness, muscle pain, dizziness and confusion, diarrhoea and vomiting. It is very important that sepsis is diagnosed before these “red flags” appear.
If sepsis is diagnosed early enough, it can be treated successfully with antibiotics without lasting consequences. If missed, the consequences can be fatal.
The NICE guidance
The new NICE guidance contains the following instructions to doctors:
- Think “could this be sepsis?” if a person presents with signs or symptoms that indicate possible infection.
- Take into account that people with sepsis may have non-specific, non-localised presentations, for example feeling very unwell, and may not have a high temperature.
- Pay particular attention to concerns expressed by the person and their family or carers, for example changes from usual behaviour.
- Assess people who might have sepsis with extra care if they cannot give a good history
In the same way that doctors have got used to considering the possibility of a heart attack in patients with chest pain, the new guidance aims to encourage doctors to consider the possibility of sepsis in anyone with an infection.
When doctors miss sepsis
The consequences of a doctor missing sepsis can be devastating, and the guidance is therefore a very welcome reminder that doctors need to be alert to the possibility of sepsis from day one, and should listen carefully to patients or their parents, use their judgment and, if concerned, organise emergency admission to hospital.