Recognising Sepsis

The clinical diagnosis of sepsis may be obvious, such as when someone presents to the emergency department with community acquired pneumonia or a perforated viscus; however, in other circumstances and when onset is more insidious the diagnosis of sepsis is often missed.

Early diagnosis and prompt treatment is essential as each hours delay in administering antibiotics increases risk of death by close to 8% (6). Compliance with international guidelines for the management of sepsis remains low even in countries where the guidelines have been embraced (7;8).

Sepsis occurs as a result of infection, signs suggestive of infection include:

  • Fever and/or rigors
  • Hypothermia
  • Cough, increased sputum production or dyspnoea
  • Abdominal pain or distension
  • Dysuria, urinary frequency, odour
  • New onset confusion or decreased level of consciousness
  • Recent surgery or invasive procedure with cellulitis or wound infection
  • Line associated redness/swelling/pain
  • Painful swollen joint
  • Meningism

Signs suggestive of sepsis in adults

Infection confirmed or suspected plus:

  • Temperature > 38.3C or < 36C (normal temperature does not exclude sepsis)
  • Respiratory rate > 20 / minute
  • Heart rate > 90/minute
  • Acute confusion or decreased level of consciousness
  • Hyperglycemia (blood glucose > 7.7 mmol/L in patient without diabetes)
  • Oliguria (urine output less than 0.5 mL/kg/hour)

Signs suggestive of septic shock

Infection confirmed or suspected plus:

  • Mottled or cold peripheries
  • Capillary refill time > 3seconds
  • Systolic BP < 90 mmHg or MAP < 60 mmHg
  • Purpuric rash
  • Arterial or venous lactate > 2 mmol/L
  • Oliguria (urine output less than 0.5 mL/kg/hour