Logo

Log In Sign Up |  An official publication of: American College of Emergency Physicians
Navigation
  • Home
  • Multimedia
    • Podcasts
    • Videos
  • Clinical
    • Airway Managment
    • Case Reports
    • Critical Care
    • Guidelines
    • Imaging & Ultrasound
    • Pain & Palliative Care
    • Pediatrics
    • Resuscitation
    • Trauma & Injury
  • Resource Centers
    • mTBI Resource Center
  • Career
    • Practice Management
      • Benchmarking
      • Reimbursement & Coding
      • Care Team
      • Legal
      • Operations
      • Quality & Safety
    • Awards
    • Certification
    • Compensation
    • Early Career
    • Education
    • Leadership
    • Profiles
    • Retirement
    • Work-Life Balance
  • Columns
    • ACEP4U
    • Airway
    • Benchmarking
    • Brief19
    • By the Numbers
    • Coding Wizard
    • EM Cases
    • End of the Rainbow
    • Equity Equation
    • FACEPs in the Crowd
    • Forensic Facts
    • From the College
    • Images in EM
    • Kids Korner
    • Medicolegal Mind
    • Opinion
      • Break Room
      • New Spin
      • Pro-Con
    • Pearls From EM Literature
    • Policy Rx
    • Practice Changers
    • Problem Solvers
    • Residency Spotlight
    • Resident Voice
    • Skeptics’ Guide to Emergency Medicine
    • Sound Advice
    • Special OPs
    • Toxicology Q&A
    • WorldTravelERs
  • Resources
    • ACEP.org
    • ACEP Knowledge Quiz
    • Issue Archives
    • CME Now
    • Annual Scientific Assembly
      • ACEP14
      • ACEP15
      • ACEP16
      • ACEP17
      • ACEP18
      • ACEP19
    • Annals of Emergency Medicine
    • JACEP Open
    • Emergency Medicine Foundation
  • About
    • Our Mission
    • Medical Editor in Chief
    • Editorial Advisory Board
    • Awards
    • Authors
    • Article Submission
    • Contact Us
    • Advertise
    • Subscribe
    • Privacy Policy
    • Copyright Information

ACEP Endorses Latest Surviving Sepsis Campaign Recommendations

By Tiffany M. Osborn, MD, MPH | on March 14, 2017 | 5 Comments
Features
  • Tweet
  • Click to email a link to a friend (Opens in new window) Email
Print-Friendly Version
Shutterstock.com

ACEP endorsed the latest iteration of the Surviving Sepsis Campaign (SSC) guidelines, totaling 67 pages with 93 statements on early management and 655 references.1,2 An important note: Guidelines should be a counselor, not a jailer. Guidelines provide a framework for direction and standardization where possible but require clinical context for individual patients. This summary includes items specifically pertinent to emergency medicine and is not intended to be all-inclusive.

You Might Also Like
  • Opinion: How the Surviving Sepsis Campaign Got Almost Everything Wrong
  • Should Prevention Methods for Sepsis Include IV Hydrocortisone?
  • Sepsis-3 Definitions and Reimbursement Discussions Continue
Explore This Issue
ACEP Now: Vol 36 – No 03 – March 2017

Definitions

All the data informing guideline development were based on the established definitions, not Sepsis-3. The Sepsis-3 and established definitions were modified for the purpose of guideline application.3 In the 2016 SSC guidelines, sepsis equates to the established definitions of severe sepsis (infection + organ dysfunction, including hyperlactemia) and septic shock (hypotension ± lactate). The Quick Sepsis Related Organ Failure Assessment (qSOFA) did not inform any part of the guidelines. ACEP and other organizations did not support or endorse the Sepsis-3 definitions due to patient safety concerns.4,5 The SSC guidelines acknowledged that:

  1. There is insufficient data to apply the Sepsis-3 definitions to the guidelines.
  2. Lactate is important and part of the established definition of severe sepsis (or sepsis in the guidelines). Additionally, the guidelines highlight the importance of lactate normalization. Both early monitoring and early management of hyperlactemia are key components of emergent resuscitation and patient care principles important in ACEP’s decision to support the guidelines when it did not support the Sepsis-3 definitions.

Consistent with the law of unintended consequences, even when compatible care is provided, clinicians implementing Sepsis-3 definitions may appear to provide worse care than those using established definitions on national quality metrics (see Table 1). So now there are three definitions: the established definitions, the SSC definitions that are based on the established definitions, and the Sepsis-3 definitions (see Table 1). What a mess. Which ones do we use? I suggest that we use the established definitions for care.

Mortality ratio, national quality metrics based on established definitions (expected mortality). When clinicians apply a low-acuity diagnosis (sepsis) to a higher-acuity patient (Sepsis-3 definition of sepsis), the observed mortality will be higher than expected. Results in similar care appearing worse based on different definitions applied to the same patients.

(click for larger image)
Table 1: Comparisons of Established Definitions, Sepsis-3 Definitions, and SSC Guidelines
Mortality ratio, national quality metrics based on established definitions (expected mortality). When clinicians apply a low-acuity diagnosis (sepsis) to a higher-acuity patient (Sepsis-3 definition of sepsis), the observed mortality will be higher than expected. Results in similar care appearing worse based on different definitions applied to the same patients. Note: CMS recognizes normotension + lactate ≥ 4 as septic shock

Perhaps future prospective evaluation will support the use of Sepsis-3 and qSOFA. However, that should be played out in further academic work and not via national payment metrics.

Pages: 1 2 3 4 5 | Single Page

Topics: ACEPAmerican College of Emergency PhysiciansBlood DisordersClinicalED Critical CareEmergency DepartmentEmergency MedicineEmergency PhysiciansGuidelinesRecommendationsSepsis

Related

  • Discharge Tachycardia: Remember the Big 4 and Don’t Play with Fire

    May 8, 2025 - 2 Comments
  • New Clinical Policy for Adult Patients with Acute Carbon Monoxide Poisoning

    May 7, 2025 - 0 Comment
  • How to Diagnose Eating Disorders in the Emergency Department

    March 11, 2025 - 0 Comment

Current Issue

ACEP Now May 03

Read More

5 Responses to “ACEP Endorses Latest Surviving Sepsis Campaign Recommendations”

  1. March 31, 2017

    John Reeves Reply

    Well done review! Thank you so much – very helpful

  2. April 2, 2017

    Munish Goyal Reply

    Great work, Tiffany. This very nicely summarizes the different definitions, some of the confusion, and a logical path forward.

    One thing caught my eye in table 1 — the established definition (CMS) of severe sepsis includes an elevated lactate (> 2.1 at my shop), not lactate > 4.

    • April 28, 2017

      Dawn Antoline-Wang Reply

      Thank you for pointing this out, Dr. Goyal. The table has been corrected.

  3. March 18, 2018

    Rushdi Alul Reply

    Hello Dr. Osborn,

    I am an internist working in the Chicago area and I would like to commend you for writing such an excellent article. I am contacting you in regard to a comment in your article, specifically your recommendation to use the established definitions for sepsis used by CMS. My confusion is the following. I will see on a regular basis young adults, for example, a 21 year old male complaining of fever and sore throat and noted to have a heart rate >90 bpm. After examination if appropriate, I will perform a rapid strep test. Assuming the strep test is positive I will tell him he has strep throat and treat him accordingly. However he meets the CMS guideline for sepsis, is his correct diagnosis strep throat with sepsis?? I am reluctant to use sepsis in this scenario since I am accustomed to associating sepsis with patients who display evidence of clinical or hemodynamic instability (requiring resuscitative intervention) which this young man does not have nor need. Any clarification or insight you can provide would be greatly appreciated!

  4. March 20, 2018

    Rushdi Alul Reply

    Dr. Osborn,
    I would like to commend you for writing such an excellent article. I am contacting you in regard to a comment in your article, specifically your recommendation to use the established definitions for sepsis used by CMS. My confusion is the following. I will see on a regular basis young adults, for example, a 21 year old male complaining of fever and sore throat and noted to have a heart rate >90 bpm. After examination if appropriate, I will perform a rapid strep test. Assuming the strep test is positive I will tell him he has strep throat and treat him accordingly. However he meets the CMS guideline for sepsis, is his correct diagnosis strep throat with sepsis?? I am reluctant to use sepsis in this scenario since I am accustomed to associating sepsis with patients who display evidence of clinical or hemodynamic instability (requiring resuscitative intervention) which this young man does not have nor need. Any clarification or insight you can provide would be greatly appreciated!

Leave a Reply Cancel Reply

Your email address will not be published. Required fields are marked *


*
*

Wiley
  • Home
  • About Us
  • Contact Us
  • Privacy
  • Terms of Use
  • Advertise
  • Cookie Preferences
Copyright © 2025 by John Wiley & Sons, Inc. All rights reserved, including rights for text and data mining and training of artificial technologies or similar technologies. ISSN 2333-2603