Sepsis Death from Discussion Delay

Sepsis is a condition caused when an infection, like pneumonia or a urinary tract infection, starts causing life-threatening problems throughout the body.  It requires treatment with antibiotics, intravenous fluids, sometimes even medicines to help keep the heart and blood vessels working properly.  Once the antibiotics start working, the person usually fully recovers.  Sepsis is deadly if antibiotics are not given soon enough to fight off the infection before it overwhelms the body.

Recently, a sepsis protocol was developed for use particularly in emergency departments where these patients are often diagnosed.  A protocol allows for optimal care to be faster and more uniform. Our department even programmed the electronic medical record system to alert us if a patient might possibly have sepsis based on chief complaint and the vital signs.

This article in STAT, a health industry newsletter, reports on the latest research regarding the protocol: Doctors have resisted guidelines to treat sepsis. New study suggests those guidelines save lives.

A recent large study in the New England Journal of Medicine confirmed that the sepsis protocol saves lives.  The protocol is to be started within 3 hours of arriving in the emergency department and completed in 12 hours.  The article reports:

For a typical 40-year-old with septic shock, failure to follow these protocols increased the risk of death from 11 percent to 15 percent, according to the new study. For a 70-year-old with more than one serious illness, the risk of death increases from 29 percent to 38 percent.

Who were the patients more likely to experience a delay? Elders, of course–those at the greatest risk for death in the first place..

The study did not explain why some patients did not receive timely treatments, he said. But since most of the patients were elderly and possibly suffering from more than one chronic illness, he said, some may have had prolonged discussions with doctors about whether to aggressively treat a possible infection.

Treatment is delayed in order to have a prolonged discussion as to whether the person really wants to be treated? Isn’t showing up in the emergency department enough?

The study excluded 5126 (4.6%) patients who did not have the full protocol completed within 12 hours but included data regarding this group in the appendix.  If delay to completing treatment is any reflection of delay in initiating treatment, then minority woman with heart, lung, or kidney disease are at greater risk.

The article goes on to give specific examples of how young people died because of delay. The rare youth who dies from delay stirs people to action but not the many elderly who needlessly suffer the same fate.

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