Screening and management of sepsis.

Key Questions for Screening and Managing Sepsis

1. In potentially infected seriously ill adult patients, does screening for sepsis improve clinical outcomes, including mortality, length of stay in intensive care, overall hospital length of stay, and use of mechanical ventilation compared to no screening?

• What is the accuracy and reliability of screening tests for detecting sepsis?
• How does screening for sepsis impact diagnosis and treatment?
• What harms are associated with screening for sepsis, including unnecessary treatment?

2. In adults with severe sepsis or septic shock, what is the effect of three or six hour resuscitation bundles on clinical outcomes, including mortality, length of stay in intensive care, overall hospital length of stay, and use of mechanical ventilation compared to other resuscitation strategies?
3. In adults with sepsis or septic shock or severe sepsis or septic shock, what is the effect of fluid resuscitation with balanced or unbalanced crystalloids on clinical outcomes including, mortality, length of stay in intensive care, overall hospital length of stay, acute kidney injury, and use of mechanical ventilation compare to no fluid, less fluids, or unbalanced crystalloids (normal saline)?

PICO Screening Population: Potentially infected seriously ill adult patients Interventions: Screening tests including but not limited to the quick Sepsis Related Organ Failure assessment Comparator: No screening Outcomes: Downstream diagnosis and treatment of sepsis, mortality, intensive care length of stay, overall hospital length of stay, use of mechanical ventilation, harms

PICO Treatment Population: Adults with sepsis, severe sepsis or septic shock Interventions: Resuscitation bundles, fluid resuscitation with balanced crystalloids Comparator: No fluid, less fluids, or unbalanced crystalloids Outcomes: Clinical outcomes including mortality, length of stay in intensive care, overall hospital length of stay, acute kidney injury, and use of mechanical ventilation, harms

Sepsis is a life-threatening medical condition that can lead to multiple organ failure, permanent organ damage, and septic shock. The condition is most likely to occur in patients with immune system deficiency and between 34% to 50% of in-hospital deaths in the US are related to sepsis (1). There are approximately 750,000 cases of sepsis that occur each year in the United States (US) and incidence is on the rise (2). Sepsis, though avoidable, is the most expensive condition treated in US hospitals, costs the US over $20 billion annually and accounting for just over 5% of hospitalization costs (3).

References: 1.Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, Iwashyna TJ. Hospital Deaths in Patients With Sepsis From 2 Independent Cohorts. JAMA. 2014;312(1):90-92.doi:10.1001/jama.2014.5804 2.Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003 Apr 17;348(16):1546-54. PubMed PMID: 12700374. 3.Agency for Healthcare Research and Quality (AHRQ), Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project (HCUP), Nationwide Inpatient Sample (NIS), 2011

The ACP will develop a guideline based on the EPC report.

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