Every Hour Untreated Sepsis Survival Drops 4% — Here Are the Symptoms to Watch For

Twelve-year old Rory Staunton took a dive for a basketball during gym class and came up with a cut on his arm. The school nurse applied a couple of band-aids, without cleaning the cut, and off he went. In approximately three days, hospital physicians told his parents there was nothing else that they could do for their son; he was dead.

Rory died of sepsis, a condition which should become a household word because of its danger, and immediate threat of death.

According to an article in the New England Journal of Medicine, sepsis impacts more than 1.5 million people per year, causing intense suffering, grief, and death. At least one in five victims do not survive. Regarding healthcare, sepsis carries a price tag of approximately $20 billion per year.

Although Rory was quickly evaluated by hospital physicians when he started feeling poorly, his condition went unrecognized. Doctors diagnosed with a stomach bug — they did not recognize the infection and ensuing sepsis until it was too late to save him. As a result, New York enacted sepsis protocols collectively called "Rory's Regulations," that require hospitals to use a rigorous process for treating and managing potential cases of sepsis.

What Is Sepsis?

Sepsis is the deadly response mounted by the body in response to infection. Most of the time, the body meets an infection with an immune response that knocks the attacking germ down. In other cases, more commonly with urinary, gut, and lung infections, the body — determined to get the upper hand — triggers an overwhelming immune response against the pathogen that ends up damaging the organs and potentially killing the patient. As with Rory, it happens fast.

An underlying infection plus any one of these symptoms could mean sepsis.

Groups of bacteria often associated with sepsis include Escherichia coli (E. coli), Streptococcus, and Staphylococcus aureus. While the young and immune-compromised people are easier targets for sepsis, it can hit anybody.

Sepsis is usually associated with an active infection, for example, in Rory's case his body mounted a fatal offense to the infected cut on his arm. For many patients with infections, the signs of sepsis come on suddenly: A worsening of symptoms, or addition of new, frightening symptoms like shortness of breath, mental confusion, rapid heartbeat, chills or sweat, and pain.

To evaluate the impact of the new protocols included in the Rory Regulations, researchers at the University of Pittsburgh School of Medicine analyzed data from 49,331 patients diagnosed with sepsis between April 2014 and June 2016. The researchers published their findings in the New England Journal of Medicine. Because Rory's Regulations require rapid treatment, the study explored whether they created changes how long it took for doctors to recognize and to treat sepsis, and if that saved lives. The short answer is "yes."

Fast Treatment of Sepsis Saves Lives

"Some question the benefit of rapid treatment with protocols, saying they can have unintended side effects and be a distraction in busy emergency departments," lead author Christopher W. Seymour said in a press release. "After reviewing the data, we can finally say that faster is better when it comes to sepsis care."

The sticking point with Rory's Regulations is the "three-hour bundle." Three hours is the window of opportunity, under the guidelines, when hospitals must complete a blood culture, evaluate tissue stress, and administer antibiotics.

After evaluating patients at 149 hospitals, the research team found 83% completed the required tests within the time allotted, with an average time of 1.3 hours. The critical finding of the study is that "for every hour that it took clinicians to complete the bundle, the odds of the patient dying increased by 4 percent." In addition to the value of fast evaluation, the study showed that quick administration of intravenous fluid might not be as helpful as rapid treatment with antibiotics.

Senior author on the study, Mitchell Levy, of the Warren Alpert Medical School of Brown University, said: "Minutes matter, and it is critical to perform the correct tests and get the patient antibiotics as fast as possible."

Earlier this year New York Governor Cuomo revisited the launch of Rory's Regulations, remarking that "New York has been leading the fight against sepsis and, as these new figures show, our efforts are working to save lives and increase early detection and treatment of this deadly condition."

Governor Cuomo reported on the results of a different research study that ran from 2014 to 2016. The study found that identification of sepsis cases had increased by 20%, while adult mortality rates from sepsis had declined from 30.2% to 25.4 percent.

If you have an infection or a wound, and you experience sudden, serious symptoms — get medical advice quickly. Mention that you're worried about sepsis to ensure you receive evaluation quickly. If you are not suffering from sepsis, it is all good. If you are? Saying it may save your life.

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Cover image via National Cancer Institute