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One study found that sepsis remains one of the leading causes of hospital deaths in the United States, but doctors may not be able to do much to prevent it.
The results were published online on February 15, 2019, in JAMA Network open now.
The study found that 88% of deaths by sepsis were not preventable.
"Although the burden of mortality badociated with sepsis is high, our study indicates that most of these deaths may not be prevented through better hospital care," Chanu Rhee, MD, MPH, Harvard Medical School, Boston, Mbadachusetts, and his colleagues write.
Many patients who have died of sepsis have had other serious medical problems, such as cancer or dementia, that may have contributed to their death.
"Our results do not downplay the importance of trying to prevent as many sepsis-related deaths as possible, but instead point out that most deaths occur in medically complex patients with severe comorbidities," the report continues. researchers.
Further progress is needed in addressing the underlying cause of death before further progress can be made in reducing the number of deaths related to sepsis, they add.
About 1.7 million people in the United States develop sepsis each year and the problem contributes to about 250,000 deaths, say the authors. To improve the situation, initiatives to improve the quality of sepsis care have been launched across the country. Some have reported a decrease in the number of deaths from sepsis after imposing a sepsis treatment protocol or package.
Yet frail individuals such as seniors and those with serious underlying conditions are among the most vulnerable to sepsis and may die, even if they receive the best care. This raises the question: how far can sepsis be avoided?
Researchers examined the medical records of 568 randomly selected adults who died while hospitalized in one of six US university and community hospitals or who had been admitted to a palliative care facility. Of these, 50.9% were men with an average age of 70.5 years.
Two trained reviewers judged the cases as to the overall avoidability of death by sepsis and suboptimal care, such as delays in starting antibiotic treatment and other medical errors.
More than half (52.8%, n = 300) of the hospital deaths in this study were due to sepsis and sepsis was the most common immediate cause of death (95% confidence interval). [CI], 48.6% to 57.0%), accounting for 34.9% (n = 198) of cases (95% CI, 30.9% to 38.9%).
Severe illness is one of the leading causes of death. The most common of these included cancer, chronic heart disease, dementia, and lung disease.
At admission, 40.3% (n = 300) of people (95% CI, 34.7% to 46.1%) had eligibility requirements for the hospice. more often terminal cancer.
Overall, reviewers found that most deaths from sepsis (88%, n = 264) were unavoidable (95% CI, 83.8% to 91.5%). They estimated that only 8.3% (n = 25) were potentially avoidable, and 1.3% were definitely avoidable.
In addition, only 22.7% (n = 300) of sepsis deaths involved suboptimal care, usually antibiotic delays.
In a related editorial, Laura Evans, MD, MSc, Faculty of Medicine at the University of New York, writes that the results should be interpreted with caution.
According to Evans, the reviewers had limited agreement in their judgments and the rate of management of suboptimal sepsis in this study was much lower than in other studies. This suggests better care for sepsis in the hospitals of this study than other hospitals in the country; therefore, there may not have been much room for improvement. If this is the case, the results could underestimate the number of preventable deaths due to sepsis due to improved care.
However, Evans continues, "this study reflects the fact that, with the tools currently available for the recognition and management of sepsis, some deaths badociated with sepsis can not be avoided."
The findings should serve as a "call to action" for sepsis research to improve the early recognition and management of sepsis, she added.
"The need for improved rapid diagnostics that can be used to trigger urgent interventions that can be applied to different resource settings is urgently needed to reduce sepsis-related deaths to their lowest possible level," Evans concludes.
The study was funded by Centers for Disease Control and Prevention (CDC) and the Agency for Health Research and Quality Health Care (AHRQ). One or more authors acknowledge royalties, honoraria, grants, and / or other funding from one or more of the following programs: UpToDate, CDC, AHRQ, Carefusion / BD, Pursuit Vascular Inc and PDI Inc. A complete list is available on the site: website of the journal. Evans reports serving on the Surviving Sepsis Steering Committee and co-chairing the Surviving Sepsis campaign guidelines.
JAMA Network open now. Posted online 15 February 2019. Full text, Editorial
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