Other studies estimate that sepsis may contribute to over 250,000 deaths every year. But what precisely is the role of sepsis in these deaths and how many of them are preventable? A team of researchers led by Dr. Chanu Rhee, a critical care physician at the Brigham and Women’s Hospital in Boston, MA, set out to investigate. Dr. Rhee and colleagues carefully reviewed the clinical management of people who died with sepsis and reached some interesting conclusions.
The acute care hospitals
The researchers examined the medical records of 568 people from six acute care hospitals between January 2014 and December 2015. The individuals include in the study either died in the hospital or hospice care. Dr. Rhee and his team of clinicians used a standardize form to review the medical records of these patients.
The researchers look for the presence of sepsis, comorbidities, “immediate and underlying causes of death,” indicators of inadequate sepsis care, such as inappropriate or late administration of antibiotics, “inadequate source control,” and the goals of care for each patient.
Using a 6-point Likert scale, the clinicians evaluate the preventability of each sepsis-relate death. The scale range from “definitely preventable” to “definitely not preventable owing to rapidly fatal illness present on admission or goals of care on admission that preclude aggressive care.” The study confirm that sepsis is highly present in hospitals and that it contributes significantly to patient deaths.
More than half of all terminal hospitalizations had sepsis, and the condition was the immediate cause of death in 198 people almost 35% of them. Importantly, however, the analysis also found that almost 90% of the deaths that resulted from sepsis were unpreventable, at least from the point of view of hospital base care.
Sepsis relate deaths were deemed
According to the review, only 1 in 8 sepsis relate deaths were deem “potentially preventable with better hospital-base care,” and only 1 in 25 were judge “moderately” or “definitely” preventable. In the few cases where suboptimal care was the reason why sepsis turn fatal; so the most common causes late antibiotic administration or source control.
So why are some sepsis induce deaths still not preventable? “Our findings do not diminish the importance of trying to prevent as many sepsis associate deaths as possible,” conclude the authors; but rather underscore that most fatalities occur in medically complex patients with severe comorbid conditions.
In other words, most of the patients include in the study were older and had several other co-occurring chronic conditions; so such as cancer, heart disease, and lung disease. Sepsis is a leading cause of death,” explains Dr. Rhee, “but since most of these deaths are occurring in very complex patients with severe comorbidities; so many of them may not be preventable with better hospital base care.
The point of this study is not to diminish the importance of sepsis quality improvement; so issues in hospitals even one preventable death is too much, adds Dr. Rhee. But, the researchers highlight the fact that their study does not account for all the other cases in which adequate hospital care did prevent death. However, “further innovation in the prevention of underlying conditions might be necessary before they can see a really large reduction in sepsis mortality,” concludes Dr. Rhee.