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Sepsis is a common condition that occurs when the body’s response to infection damages its own organs and tissues (Singer, Deutschman et al. 2016). Sepsis always starts with an infection, most commonly a bacterial infection (Shankar-Hari, Harrison et al. 2016), but the signs and symptoms of infection are not always obvious when sepsis develops. Sepsis is a clinical diagnosis – there is no single test that can confirm its presence or absence. In the early stages, it can look like self-limiting conditions, such as flu and diarrhoea, but if left untreated sepsis can lead to shock, multiple organ failure and death.
Sepsis claims the lives of an estimated 6 million people a year, worldwide (Fleischmann,Scherag et al. 2016). The UK Sepsis Trust, estimate that at least 44,000 deaths a year in the UK are attributable to sepsis, withat least one third being preventable (Daniels et al, 2018). Three quarters of the deaths from sepsis in the UK occur in patients aged over 75 (Shankar-Hari M 2016), but people with learning disabilities are more likely to die prematurely than people without learning disabilities: women 20 years younger and men 13 years younger. Concern is growing in the Learning Disabilities Mortality Review programme that sepsis is emerging as a leading cause of death in people with learning disabilities of all ages.
Worldwide, lower respiratory tract infection is the communicable disease with highest mortality – 3.2 million deaths a year in 2015, and it is the third biggest cause of death overall (WHO, 2017). In the UK, respiratory tract infection is the most common trigger for sepsis (NCEPOD, 2015). People with Learning disabilities are five times more likely to be admitted to hospital with a lower respiratory tract infection than someone of the same age & sex without learning disabilities (Hosking, Carey et al. 2017). Respiratory disease, usually pneumonia, was the immediate cause of death in one third of the deaths examined by the CIPOLD inquiry (Heslop, Blair et al, 2013) suggesting people with learning disabilities are at high risk of developing sepsis. While infection can exist without sepsis (Tidswell and Singer 2018), sepsis is the final common pathway to death from infection. However, the cause of death may be coded as the underlying infection rather than sepsis (Reinhart,Daniels et al. 2017). In the UK, a review of the care patients with sepsis received, found there was no mention of sepsis in 40% ofcases, where documented clinical signs of sepsis were evident to a panel of experts (NCEPOD, 2015).
In summary, sepsis is a worldwide phenomenon and a leading cause of preventable death. It is the final common pathway to death from infection. Understanding of the epidemiology of sepsis is growing at the same time as concern about the mortality from sepsis amongst people with learning disabilities. People with learning disabilities are at high risk of developing sepsis especially from respiratory infection. Deaths from sepsis may be prevented with early recognition and treatment.
Are we doing enough to raise awareness of sepsis amongst people with learning disabilities?
What reasonable adjustments can we make to recognise sepsis in people with learning disabilities more quickly?
How do we ensure healthcare providers are responsive to the subtle signs of sepsis in people with learning disabilities?
For more information about sepsis visit www.sepsistrust.org The UK Sepsis Trust have produced a comprehensive, accessible sepsis manual which can be downloaded for free or purchased via their online shop.
Thanks to The Sepsis Trust for letting us use their material, to Anne Hunt for the above topic.
Daniel Marsden @dmarsden49
NCEPOD 2015 JustSaySepsis_FullReport.pdf
DANIELS, R. (ed.) 2018. TheSepsis Manual: UK Sepsis Trust.
FLEISCHMANN, C., SCHERAG, A., ADHIKARI, N. K. J., HARTOG, C. S.,TSAGANOS, T., SCHLATTMANN, P., ANGUS, D. C. & REINHART, K. 2016. Assessmentof Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. American Journal of Respiratory and Critical Care Medicine, 193, 259-272.
HESLOP, P., BLAIR, P. S., FLEMING, P., HOGHTON, M., MARRIOTT, A.& RUSS, L. 2014. The Confidential Inquiry into premature deaths of people with intellectual disabilities in the UK: a population-based study. The Lancet, 383, 889-895.
HOSKING, F. J., CAREY, I. M., DEWILDE, S., HARRIS, T., BEIGHTON, C.& COOK, D. G. 2017. Preventable Emergency Hospital Admissions Among Adults With Intellectual Disability in England. Annals of Family Medicine, 15, 462-470.
NCEPOD 2015. Just Say Sepsis! A review of the process of care received by patients with sepsis.
REINHART, K., DANIELS, R., KISSOON, N., MACHADO, F. R., SCHACHTER,R. D. & FINFER, S. 2017. Recognizing Sepsis as a Global Health Priority — AWHO Resolution. New England Journal of Medicine, 377, 414-417.
SHANKAR-HARI, M., HARRISON, D. A. & ROWAN, K. M. 2016.Differences in Impact of Definitional Elements on Mortality Precludes International Comparisons of Sepsis Epidemiology—A Cohort Study Illustrating the Need for Standardized Reporting*. Critical Care Medicine, 44, 2223-2230.
SINGER, M., DEUTSCHMAN, C. S., SEYMOUR, C. & ET AL. 2016. The third international consensus definitions for sepsis and septic shock(sepsis-3). JAMA, 315, 801-810.
TIDSWELL, R. & SINGER, M. 2018. Sepsis - thoughtful manage mentfor the non-expert. Clinical Medicine(London, England), 18, 62-68.
WHO, W. H. O. 2017. The top 10 causes of death Available: http://www.who.int/mediacentre/factsheets/fs310/en/.