Rapid scoring system could help ER doctors recognize sepsis more quickly
Published Tuesday, June 13, 2017 10:00PM EDT
Last Updated Tuesday, June 13, 2017 10:26PM EDT
An Ontario doctor says she would like to see hospitals across the country use an early warning system to detect cases of sepsis, a life-threatening but often-overlooked condition that kills close to 10,000 people in Canada each year.
Sepsis, also referred to as blood poisoning, is a serious illness that can be triggered by an infection or an injury. It occurs when the immune system goes into overdrive while fighting an infection, which can reduce blood flow to vital organs.
The World Health Organization recently declared sepsis a new health priority. In the developed world, incidence of sepsis has been increasing at an annual rate of between five and 13 per cent over the last decade.
Dr. Alison Fox-Robichaud, a critical care specialist at Hamilton Health Sciences, said an estimated three per cent of patients seen in emergency departments may have sepsis, but nurses and doctors may not realize that right away.
“Sepsis is more fatal than people having acute heart attacks. And it’s common,” Dr. Fox-Robichaud, who is also a professor at McMaster University’s department of medicine, told CTV News.
The problem, she said, is that “unless you’re really looking for it, you’re going to miss it until people get really sick.”
According to the Canadian Patient Safety Institute, sepsis affects about 30,000 Canadians each year and more than one-third of them will die if not treated appropriately.
Signs of sepsis can include a fever, difficulty breathing, a sharp drop in blood pressure, high heart rate, confusion, and significantly decreased urine output.
A study co-authored by Dr. Fox-Robichaud found that using early warning scores to identify critically ill patients at Hamilton Health Sciences was often successful in detecting sepsis in earlier stages.
Early warning scores use patients’ vital signs, such as blood pressure, heart rate, temperature, oxygen saturation and level of consciousness, to determine who is at risk of “critical deterioration.”
“(The study) demonstrated, at least retrospectively, that if we’d had that early warning score in place in the emergency department, we may have picked up septic patients earlier,” Dr. Fox-Robichaud said.
She would like to see hospitals across Canada use the early warning score to specifically screen for sepsis.
Madelynn Fairman agrees. She is a Hamilton, Ont., nurse who developed sepsis after suffering from strep pneumonia in 2015. What started out as a sore throat and an earache developed into shortness of breath, which Fairman initially attributed to her smoking habit.
But an infection that spread from Fairman’s lungs to her kidneys and liver landed her in hospital with sepsis.
“I was on death row for over 17 days,” Fairman told CTV News. “They called my family in night after night, after night. They said there is nothing more we can do.”
Despite the grim prognosis, Fairman eventually recovered.
“I never dreamt that could happen to me,” she said, adding that as a nurse who has treated septic patients, she should have recognized the danger.
For Krista Messier, sepsis had devastating consequences. The 30-year-old went from complaining of a headache and fever to being placed on a ventilator in the intensive care unit.
She is still unable to move or talk.
“This should not be happening to a 30-year-old girl,” her mother, Joy Messier, told CTV News.
Dr. Fox-Robichaud said sepsis caused serious damage to Krista Messier’s organs, brain and spinal column.
“Unfortunately it has left her with significant disability that we hope over time will get better,” she said.
Dr. Fox-Robichaud said detecting sepsis in young people is particularly challenging because they may not appear to be that sick when they arrive in the ER.
Patients who don’t receive treatment right away can be “profoundly affected for weeks and months and years afterwards,” she said.
Sepsis can lead to long-term weakness, organ damage and loss of cognitive abilities. The death rate depends on the overall health of the patient, and can be as high as 50 per cent. But on average, it’s somewhere between 25 and 30 per cent, Dr. Fox-Robichaud said.
In the U.K., health officials have taken an aggressive approach to sepsis, saying it should be treated as an emergency, just like heart attacks.
Draft guidelines released in March by the U.K. National Institute for Health and Care Excellence say that patients with suspected sepsis and at least one criteria for high risk of severe illness or death must be reviewed by a senior doctor in hospital within an hour and started on IV fluids and antibiotics immediately.
Dr. Fox-Robichaud is hoping to increase awareness of sepsis not just among Canadian health care professionals, but among the wider public.
“If you got a bad infection, and you think something is wrong --- get yourself to the emergency department.”
With a report from CTV’s medical specialist Avis Favaro and producer Elizabeth St. Philip