In February, 2023, medical researchers published an article on behalf of the Society of Critical Care Medicine entitled “Diagnostic Delays in Sepsis: Lessons Learned from a Retrospective Study of Canadian Medico-Legal Claims“.
The authors note that although rapid treatment improves outcomes for patients presenting with sepsis, early detection can be difficult, especially in otherwise healthy adults.
Sepsis is organ dysfunction caused by a dysregulated host response to infection and is life-threatening, with greater risks for people under 1 year old or in higher age groups. There were an estimated 11 million sepsis-related deaths worldwide in 2017, and for septic shock, in particular, the mortality rate has decreased very little in recent decades despite advances in sepsis management.
Outcomes for patients with sepsis can be improved through the early recognition of sepsis and appropriate management, which may include prompt consultation and admission to ICU. Yet early detection can be difficult. Of patients who experience sepsis, the estimated proportion with a missed or delayed diagnosis ranges between 8.2% and 20.8%. In an effort to help with early detection, researchers have redefined sepsis and validated criteria for identifying high-risk patients.
The key point of this study was to determine what patient characteristic and elements of healthcare contributed to a diagnostic delay of sepsis. Furthermore, the authors looked to find potential warnings signs for patients at risk of developing severe sepsis.
By using retrospective medical-legal data supplied by the Canadian Medical Protective Association (“CMPA”), the authors found that mortality rates associated with sepsis were relatively high at 49%.
The most common specialities of physician implicated in a sepsis-related diagnostic concern included family medicine, emergency medicine, and surgery.
Deficient assessments, including failure to include sepsis in the differential diagnosis, contributed to the majority of cases in this study. Almost half of the patients had multiple visits to outpatient care prior to the recognition of sepsis.
Almost 40% of patients in our series were admitted to the ICU during their hospitalization, and mortality rate was high in this group. Criticism of the care received in the ICU or provided by critical care physicians, however, was uncommon. This underscores the importance of early diagnosis and also suggests that diagnostic issues related to sepsis occur prior to admission to ICU.
Providers should consider the importance of prompt, in-person assessments of patients to reduce potential delays in ordering appropriate tests or supporting the diagnostic process. Critical care physicians might also consider how best to coordinate the care of patients at increased risk of sepsis with their surgical, emergency department and hospitalist colleagues, as appropriate care and prompt admission to ICU may improve outcomes.
Delayed diagnosis of sepsis is a preventable cause of death and may be the result of medical malpractice.
