More than one in 100 patients attending an emergency department (ED) in Ireland is affected by the life-threatening condition of either severe sepsis or septic shock, new research has found.
Despite its potentially fatal consequences, and the central role the ED plays in its early identification, its prevalence in Irish EDs has not been measured until now.
There were more than 15,000 recorded cases of sepsis in the country in 2016, resulting in 3,000 deaths.
The authors of the study warn that their finding “could be an underestimate” on the basis that organ dysfunction — a symptom of sepsis — is not always documented in the ED, as all relevant laboratory results may not be available.
The study, ‘The Prevalence of Severe Sepsis or Septic Shock in an Irish ED’, published in the Irish Medical Journal, found the most common suspected source of sepsis in patients who met the criteria for severe sepsis or septic shock was the respiratory system.
The genitourinary system was the second most common source. The elderly were most affected.
In conducting the study, the clinical records of patients presenting to Beaumont Hospital ED in Dublin over a four-week period were retrospectively reviewed. Overall, 3,585 adult patients attended during the study period, with 42 patients meeting the criteria for severe sepsis or septic shock.
The study found patients who met the criteria were “significantly older” than those who did not.
“This is consistent with previous studies reporting sepsis as a disease of the elderly,” the authors said. They said it was explained in part by the presence of other illnesses in the older patient.
Five patients with severe sepsis or septic shock, with a median age 61, were transferred to the intensive care unit (ICU) for further management. The median age of males was 75, significantly older than women, at 68.
The study’s authors said measuring prevalence data “is critical in determining healthcare resource allocation”, especially as the majority of patients with severe sepsis are admitted to ICUs from the ED.
Sepsis, known as blood poisoning, was recently described in an RCSI public lecture as “a silent killer because it is unpredictable, rapid and can go undiagnosed due to its non-specific signs and symptoms”, and as killing “more Irish people than heart attack, lung cancer or breast cancer”.
Severe sepsis and septic shock are among the leading causes of death globally, accounting for more than 15m deaths annually. They remain a major cause of ED attendances and ICU admissions and are associated with significant illness, death and healthcare costs.
In Ireland, up to three in five of all hospital deaths has a sepsis or infection diagnosis.
“Consequently, the public health burden of these conditions is substantial,” the authors said.
Ireland’s national clinical guideline on sepsis management states that sepsis incidence is predicted to grow at a rate of 1.5% annually, partly due to an aging population, increased numbers of invasive procedures and the increasing number of people living with co-morbidities and on long-term immunosuppressive therapies. It describes sepsis as a “common” and “time-dependent” medical emergency.
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