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Sepsis death rates ‘unacceptable’

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Nurses must learn to tell the difference between types of sepsis more quickly if mortality rates are to be tackled effectively, according to specialists.

They say patients presenting to UK emergency departments with severe sepsis have an ‘unacceptably’ higher mortality rate than those with uncomplicated sepsis.
Between March and April 2006, researchers analysed data on 310 patients admitted to Southampton General Hospital A&E with sepsis.
Of these, 260 were diagnosed with either systemic inflammatory response syndrome (SIRS) or uncomplicated sepsis, while a further 50 had severe sepsis or septic shock.
The researchers found the mortality rate for those with severe sepsis was 26%, compared with just 6.6% for SIRS and 4.1% for uncomplicated sepsis.
Patients with severe sepsis also had a significantly longer hospital stay of 7.5 days, compared with five and three days for those with SIRS and uncomplicated sepsis respectively.
The authors said that the late recognition of the disease and inappropriate treatment before patients were admitted to ICU were partly responsible for the ‘unacceptably high’ mortality rate.
Carys Jones, sister in critical care at the Royal Berkshire Hospital in Reading, said: ‘What happens in the first hour can make a significant difference to the patient’s chances of survival. Every hour delayed increases mortality by 7–8%.
‘Early identification is the key, so staff across the whole hospital need to be educated to recognise the symptoms.’
Ron Daniels, chairperson of the Surviving Sepsis Campaign, said: ‘The first six hours from the onset of symptoms are crucial and emergency departments across the UK need to start implementing evidence-based guidelines for the management of severe sepsis as soon as possible.’
Guidance issued by the Surviving Sepsis Campaign states that, within one hour of recognition of severe sepsis, blood cultures should be taken, serum lactate levels measured, intravenous antibiotics and fluids started and oxygen therapy administered.

Emergency Medicine Journal (2008) 25: 11–14

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