Sepsis 3 from the perspective of clinicians and quality improvement initiatives

Lactate ≥2 mmol/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis

“…Several recent studies have focused on the prognostic accuracy of the qSOFA score, generally reporting high specificity but low sensitivity. These findings would be consistent with a primary role for qSOFA as a severity marker rather than a screening tool …”

“…Our cohort of patients thus represents a group with an inherent higher risk for adverse outcome than the general population of patients with suspected infection. For diseases with a high risk for adverse outcome, systems that are highly sensitive aim to identify such patients in EDs and inpatient settings . Until a robust system for screening patients with suspected infection is validated, SIRS‐based screening is likely to continue and may continue to miss patients who are not selectively then screened with qSOFA scoring, lactate measurements or SOFA score calculations at sites with implemented sepsis management programmes .…”

In the Literature

“…One potential unintended consequence of the new criteria is that some patients who could benefit from early recognition of and intervention for serious infection may suffer for lack of meeting the Sepsis-3 criteria. This concern is consistent with those raised by Machado and colleagues who, while agreeing that the older SIRS criteria have poor discriminant value, assert that they still have "an important role in identifying patients with infection who may benefit from antimicrobial therapy, fluids and additional screening for organ dysfunction" [3]. Large prospective studies will be necessary to resolve this issue.…”

Economic disparities and survival from critical illness

“…According to critics, Sepsis-3 was a definition written by and for North American and Western European intensivists, 4 with insufficient consideration given to sepsis in much of the rest of the world. 4,5 Similar concerns have been raised about acute respiratory distress syndrome (ARDS). In a study 6 at a tertiary care hospital in Rwanda, investigators needed to re-define the disease (which has been termed the Kigali modification of the Berlin Criteria) to study the incidence and mortality of ARDS.…”