COMMENTARY

Sepsis Hysteria: The Emotionally Charged Debate

Alok S. Patel, MD

Disclosures

January 31, 2020

This transcript has been edited for clarity.

If you haven't checked out the Lancet article about sepsis hysteria, I highly recommend it—it has led to a lot of intellectual debate.

When I have a hospitalized patient with an infection, I always think about the possibility of sepsis. It's a healthy paranoia. However, I feel added pressure when patients bring up statistics that they've read—things like "1 in 3 hospitalized patients who die had sepsis" or "every sepsis death is a preventable tragedy."

We know the data are not always generalizable and that, sadly, not every sepsis death is preventable even with the best care. This is what the authors of the Lancet article are emphasizing. We want to do right by every patient with sepsis, but the inaccurate portrayal of sepsis epidemiology can raise public alarm and influence how we practice. 

The authors made several key points about changes in behavior and the overall amount of sepsis cases reported. One main change in behavior is the increase in the amount of antibiotics prescribed. That's because the guidelines say they need to be started within 1 hour of presentation. The authors take aim at the evidence behind this guideline.

There is also reference to a study which shows that approximately 40% of sepsis diagnoses were not actually tied to a confirmed infection. Another study showed that changes in ICD coding actually increased the amount of sepsis diagnoses.

And lastly, the authors of the Lancet article made the point that even with everything done appropriately, many patients with sepsis will inevitably die. This is nothing that a guideline is going to fix; it may be because of underlying chronic illness or comorbidities.

In the end, it's pretty easy to see why there was such an emotionally charged debate on social media about all of this. You can check it out by searching #SepsisHysteria. On one hand, you have sepsis advocacy groups who are trying to spread awareness, and patients who are outraged that we are even having this discussion. On the other hand, you have scientists and doctors who are trying to separate fact from fiction and get a better grasp on sepsis epidemiology out to the masses so we can prevent overtreatment and overdiagnosis. This is the heart of what the authors of the Lancet article were saying.

The emotional debate was neatly summarized in a perspective piece for the BMJ, but we want to hear what you think. Do you think the "hysteria" is warranted? Do you think there is something else we should be doing in how we look at sepsis?

Comment below!

Dr Alok S. Patel is a pediatric hospitalist, television producer, media contributor, and a digital health enthusiast. He splits his time between New York City and San Francisco as he is on faculty at both Columbia University/Morgan Stanley Children's Hospital and the University of California San Francisco, Benioff Children's Hospital. Alok hosts The Hospitalist Retort video blog on Medscape and is a medical producer at CNN.

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