Sepsis: raising awareness
Following the recent inquest of Charlie Jermyn and the tragic death of William Mead, children who both died from sepsis in 2015 and 2014 respectively, the infection and its prevention have become important issues.
Charlie Jermyn died from sepsis at just 30 hours old, when signs of the infection were dismissed as feeding problems.
Toddler William Mead died in December 2014, after GPs and call handlers from the NHS 111 helpline failed to recognise he was suffering from sepsis, instead diagnosing him with a common cough. William’s mother called 111 the day before William’s death and also spoke to an out-of-hours GP who had no access to his medical records. The NHS England report concluded that if a medic had taken her call that day, they probably would have recognised that William required urgent medical attention.
What is sepsis?
Sepsis is the body’s reaction to an infection when the immune system goes into overdrive. This means that the body attacks its own organs and tissues. If it is not treated quickly, it can lead to organ failure and death.
Sadly, and somewhat shockingly, sepsis accounts for 37,000 deaths annually in the UK. That is more than bowel cancer and prostrate cancer put together. This means that a person dies from this infection every 14 minutes.
A report into William’s case found 16 mistakes in his care and that he may have lived, but for a catalogue of missed opportunities to diagnose he was suffering from sepsis. Last year, there were 27,000 episodes of the infection among children aged up to four and the Sepsis Trust estimates that this accounts to 1,300 deaths in the under fives.
The review, by the National Confidential Enquiry Into Patient Outcome and Death (NCEPOD), said there are an estimated 200,000 cases a year in the UK. In a third of the cases where a GP saw the patient, not one of the four basic vital signs of temperature, pulse, blood pressure and respiratory rate had been recorded.
With these statistics in mind, it is important to know the common signs of sepsis. The difficulty is that, as happened with William Mead, in the early stages, it is often difficult to distinguish it from flu.
Symptoms can develop quickly and include:
- A high temperature or fever;
- Chills and shivering;
- A fast heartbeat;
- Fast breathing.
In some cases, symptoms of more severe sepsis can develop within hours. These can include:
- Feeling dizzy or faint;
- A change in mental state, such as confusion or disorientation;
- Nausea and vomiting;
- Slurred speech;
- Severe muscle pain;
- Severe breathlessness;
- Decreased urine production (for example, not urinating for a day);
- Cold, clammy and pale or mottled skin;
- Loss of consciousness.
If there is a suspicion of sepsis, urgent medical attention is required. Caught early, the outlook is good for the vast majority of people and treatment is usually through the administration of antibiotics.
However, international recommendations suggest that the treatment should be started within one hour of sepsis being suspected.
The Sepsis Trust stated that hospitals were still not acting quickly enough to treat sepsis, specifically spotting the ‘red flag’ symptoms. The tragic cases above highlight these concerns.
The trust developed ‘The Sepsis Six’ which is designed to offer basic intervention within the first hour. These are:
- Administer high-flow oxygen
- Take blood cultures and consider infective source
- Administer intravenous antibiotics
- Give intravenous fluid resuscitation
- Check haemoglobin and serial lactates
- Commence hourly urine output measurement
With more implementation of relevant training to hospitals and individual health professionals, let us hope that there will be fewer cases such as that of William Mead and Charlie Jermyn.
Lyons Davidson clinical negligence department has dealt with many cases in relation to delays in treating infections. If you would like more information about any of the points raised in this article or if you think you have been affected by any delays in treatment, please contact our Clinical Negligence team by emailing [email protected].
Posted on Feb 26th, 2016 by Lyons Davidson