A recent “Opinion” article by three distinguished professors from Harvard and Washington University in St. Louis titled “Who Owns Sepsis?” was published in the January 2020 issue of the Annals of Internal Medicine addressing the limitations of the Sepsis-3 definition.
Widespread skepticism in the general medical community outside the critical care specialty has been expressed about the Sepsis-3 definition of sepsis as “life-threatening organ dysfunction” due to infection. These clinicians worry that the requirement for acute organ dysfunction will result in missed opportunities to identify “early” sepsis before acute organ dysfunction develops requiring ICU admission with its associated morbidity and mortality.
The authors forcefully and convincingly argue that the clinical concept of “early” sepsis preceding acute organ dysfunction is clinically valid and cannot be omitted from a sepsis definition.
While Sepsis-3 proposed a quick-SOFA (qSOFA) screening tool to prompt full SOFA scoring, it is not designed to identify “early” sepsis without organ dysfunction. Shannon et al. published a study in the February 20, 2018 issue of the Annals of Internal Medicine showing that the SIRS criteria were more accurate than qSOFA in predicting organ dysfunction.
The authors also expressed concern about the risk of over-treatment from a single management protocol for patients that may present with a broad range for severity. One size does not fit all even with acute organ dysfunction. A more balanced approach to sepsis diagnosis and management informed by the urgency and intensity of therapy needed is suggested.
They also point out that 50 of the 59 members of the Surviving Sepsis Campaign (SSC) panel, which adopted the Sepsis-3 criteria, are critical care specialists while 85% of sepsis cases are managed by non-intensivists.
Since SSC has been the authoritative custodian for a unified international definition and management protocol for sepsis, the authors advocate the inclusion of more Emergency Physicians, Internal Medicine and Family Medicine specialists on the SSC panel.
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