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.
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!
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!
5 Responses to “ACEP Endorses Latest Surviving Sepsis Campaign Recommendations”
March 31, 2017
John ReevesWell done review! Thank you so much – very helpful
April 2, 2017
Munish GoyalGreat 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-WangThank you for pointing this out, Dr. Goyal. The table has been corrected.
March 18, 2018
Rushdi AlulHello 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!
March 20, 2018
Rushdi AlulDr. 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!