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Sepsis: a killer that changes it name

I'm always relieved when a story in the press focuses on raising awareness of the medical condition of sepsis and its potential to be devastating.

I deal with too many terrible cases where a diagnosis of sepsis in hospital or in a GP's surgery comes too late and the consequences are fatal or result in permanent disability. Particularly traumatic, of course, is when young children – who are especially vulnerable to the condition - are involved.

So, the World Health Organisation's mandate to every member state last May to have national action plans in place to tackle sepsis is especially welcome among the Personal Injury and Medical Negligence team here, along with the admittedly tabloid but effective description of the disease as the "deadliest killer you’ve never heard of". We'll support pretty much anything that might help prevent some of the 44,000 UK deaths from sepsis every year, that's more than bowel, breast and prostate cancer combined.

Put briefly, sepsis occurs when the body’s response to infection causes organ dysfunction. This can happen when the body's immune system is simply overwhelmed by the infection or it fails to respond and produces too much inflammation, often because it is already battling with trauma or an initial infection and it simply cannot cope. The typical treatment is rapid administration of antibiotics that usually have a good effect if it happens early .

A health burden equal to tobacco

Even conservative estimates place the annual global death toll from sepsis at six million, that's a health burden similar to that of tobacco. But according to the Guardian, a recent survey found that 44 per cent of people in this country have never heard of sepsis and have little idea that it is a life-threatening emergency because, somehow, it's slipped under the radar.

The Guardian partly explains this because the majority of deaths caused by sepsis are not accurately reported. Apparently one study found that sepsis was only written on the death certificate in 40 per cent of cases where patients had died from the condition. Even patients who have survived and been discharged from hospital are often unaware that they've even had it.

According to Dr Ron Daniels, founder of the UK Sepsis Trust, a patient may be admitted with a chest infection and end up in intensive care with multi-organ failure, "but they think they’ve just had pneumonia, not realising it was sepsis."

What's in a name?

Part of the confusion is in the terminology. Of Greek origin, the word "sepsis" has existed for thousands of years, but the medical community only came to its conclusive definition of the condition in 1991. As a result, terms ranging from "blood poisoning" to "septicaemia" have been used to describe the same thing, so it's little wonder people aren't clear. Despite being the most common cause of deterioration and death in secondary-care settings, that confusion has resulted in a lack of specific funding for better sepsis care.

The positive news is that rates of sepsis are beginning to fall, not least because the NHS now provides GPs with automated prompts alerting them to potential sepsis cases, while staff are encouraged to think of sepsis in response to a high national early-warning score. Ambulance teams now alert hospital emergency services of incoming sepsis patients, as they do with heart-attack and stroke patients.

The result is that mortality rates from sepsis in patients admitted into intensive care have fallen from 35 per cent to 27 per cent within 10 years.

Clearly, there's a way still to go and the main challenge is to improve early diagnosis by all medical staff, teaching them to watch out for the often very subtle initial signs.

As Dr Daniels sums up: "All the changes being made still rely on someone actually thinking sepsis and considering it as a possibility. They [the changes] are useless otherwise."

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