National approach to sepsis needed: researchers

Academics are calling for a national approach to sepsis detection, after new research discovered that an internationally recommended early detection system for sepsis proves less effective than the Australian alternative.

Statistics show that Sepsis kills more than 5,000 people each year, and the new research warns against adoption of the internationally recommended Quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for early detection of suspected sepsis in hospital patients – instead suggesting the widespread adoption of SEPSIS KILLS Adult Sepsis Pathway (ASP).

Lead author of the paper Associate Professor Ling Li, from the Australian Institute of Health Innovation at Macquarie University, says that ASP would have triggered a warning for more than 90 per cent of cases who died in hospital and the warning would have been triggered eight days before death for half of cases; while in two-thirds of cases qSOFA would have triggered no warning at all before the patient died.

“For a patient with sepsis, every hour delay in the commencement of treatment with antibiotics significantly reduces their chance of survival,” Li explained, and she believes ASP should be adopted nationwide.

“We know this is really a serious problem, and all these simple criteria introduced by the Adult Sepsis Pathway basically give clinicians some judgement.

“I think there are other studies have done as well on this Adult Sepsis programme that prove it's effective and save lives,” she said.

 

qSOFA has been put forward as an effective tool for early detection of sepsis however our research shows this is not the case and we are calling on all Australian hospitals to use ASP to ensure the best care for patients,” Associate Professor Li said.

According to the Australian Sepsis Network, Sepsis is defined as organ dysfunction due to an infection. The annual incidence in the adult Australian population treated in an ICU has been estimated at 0.77/1000; corresponding to more than 15,700 new cases each year with an estimated cost of $39,300 per episode.

Kelly Thompson, Global Program Manager of the Women's Health Program at the George Institute for Global Health, agrees that a national response to sepsis is needed but does not discount the efficacy of qSOFA out of hand.

She points out that qSOFA is quick and accessible in comparison to other detection methods and is particularly helpful in rural and remote areas.

“You don't need access to arterial blood gap monitoring to test blood. It's a very accessible tool and I think what's happened is a lot of people globally have looked at the performance of qSOFA and there's a lot of criticism against it,” she says.

“But I suspect the point of developing the qSOFA in the first place was something that could be truly accessible globally. It doesn't matter if you're in rural and remote Australia, or you're in Africa, with no access to blood testing or the fancy equipment that a lot of hospitals in the inner-city areas have. You can still actually implement a test that might identify patients that are at a higher risk of dying.”

Sepsis numbers 'twice as high as previously thought'

Thompson believes that to initiate a national approach to sepsis will require a lot of cooperation between states and tweaking of the pathways in accordance with the needs of the various states. The issue becomes more urgent with the the emergence of more accurate sepsis numbers coming to light in recent months which show that sepsis has gone underreported globally for years.

“They've done the first really comprehensive analysis, and what they've found in this study is sepsis incidence is twice as high as previously thought, and the reason for that is because previously they were only really able to measure incidence and mortality from data in high income countries,” Thompson says.

“But now they've got access to this global burden of disease study, which has a lot of low- and middle-income countries and the findings here show 48.9 million incident cases of sepsis, so that's new cases a year. 11 million deaths, more than double what they previously estimated.”

These new stats would put the number of Australian cases at 55,000 and deaths at 8,700 per year.

Sepsis is a challenging issue as it can happen to anyone at any age in any part of the body, and for this reason educating the public about sepsis is an important way to combat the issue, Thompson says.

“I think in a hospital setting, most particularly in New South Wales, I know the Adult Sepsis Pathway has been really, really well implemented, and evaluated in terms of improving sepsis recognition,” she says.

“However, I think again, as I said, 80 per cent [of cases] come through the community and I don't know specifically in the primary care setting for example, what kind of recognition of sepsis, if they're using any tools.

“I think a bit better integration of care across the healthcare system, so from primary setting, primary care settings to tertiary settings is really important in reducing bad outcomes from sepsis.”

Both Li and Thompson emphasise the crucial role nurses play in any sepsis detection.

“They are the first contact of the patients, and they actually observe the patient. They probably can identify the signs early and then refer to the senior clinicians. Another thing I want to emphasise is our study focused on the ward patients. A lot of the private studies will focus on ICU and ED, but actually majority of people have sepsis in general ward,” said Li.

“There's a bit of a misconception around sepsis being hospital acquired, as in you get it in hospital, but actually about 80 per cent of Sepsis cases comes through the emergency department,” says Thompson.

“The first point of contact with the healthcare system in the emergency department specifically, when you're presenting that way, is a triage nurse. They're really important. And also, outside of that setting, in a hospital setting on a ward, even in clinics, nurses are often the ones that are doing the vital signs checking for patients. They’re incredibly important to picking it up.”

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