Editorial Cites 'Growing Fatigue' Around Sepsis Reports

The Lancet Respiratory Medicine's editorial notes that early detection of sepsis is vital but is hampered by signs and symptoms of the condition being similar to other disorders.

The Lancet Respiratory Medicine has published an editorial this month titled "Crying wolf: the growing fatigue around sepsis alerts," which suggests that sepsis alerts from primary care systems are being "over-triggered," and that doctors may become desensitized to the high number of frequent alarms and fail to spot real cases of sepsis.

The editorial says sepsis is challenging to diagnose, particularly in the early stages, even though the global incidence of sepsis is estimated to be around 30 million episodes annually. "According to the UK Sepsis Trust, sepsis claims more lives per year in the UK than lung cancer, and more lives than bowel, breast, and prostate cancer combined," it says. "Complexity in the diagnosis of sepsis arises from the heterogeneity of this disorder—it can be caused by a wide range of pathogens acting on different organs. The definition of sepsis has also changed, owing to increasing understanding of its pathobiology, and in 2016, consensus definitions emphasized organ dysfunction as a key factor in its characterization."

It mentions two UK reports that highlighted avoidable deaths from sepsis, recommending earlier detection and treatment and having clinical settings consider sepsis as an immediate life-threatening condition that should be treated as an emergency. This brought about automated alerts for the identification of sepsis, a series of escalating prompts when a doctor records potential symptoms of sepsis in the patient's electronic health record.

"There is now increasing anecdotal evidence, and an admission by the UK National Health Service (NHS) England in January, 2018, that sepsis alerts from primary care systems are being over-triggered," the editorial says. "Doctors have pointed to a low threshold for sending alerts, with example complaints including alerts being triggered when a patient's temperature is measured, but no fever has been recorded. The consequence is so-called alert fatigue, where doctors become desensitized to the high number of frequent alarms, which can lead to alerts being ignored or switched off, and real cases of sepsis being missed."

It is not yet clear whether the alerts are being triggered too often because of issues with implementing the algorithm or problems with the algorithm itself, it says.

The editorial's summation notes that early detection of sepsis is vital but is hampered by signs and symptoms of the condition being similar to other disorders. "GPs see many patients with symptoms of infection, but the proportion that will have sepsis is very small. Alerting systems to help doctors should have a high specificity and sensitivity, present clear information, facilitate safe and efficient handling of the alerts, and shouldn't unnecessarily disrupt workflow. A careful assessment of the system is also needed to ensure these criteria are met, and that the correct balance between false and valid alarms is achieved. Alerts must maintain their intended urgency and attention-grabbing power," it says.

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