Australian system to detect sepsis is best

International system proves less effective

1 February 2020

An internationally recommended early detection system for sepsis, a condition that kills more than 5,000 people in Australia each year, proves less effective than the Australian alternative.

New research from Macquarie University warns against adoption of the internationally recommended Quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for early detection of suspected sepsis in hospital patients.

Early detection of sepsis is the best defence against this often-fatal condition but for two thirds of cases in the study, qSOFA would not have triggered a warning of sepsis prior to the patient’s death.

In Australia, the most used sepsis risk identification tool for patients in hospital is the SEPSIS KILLS Adult Sepsis Pathway (ASP) implemented by the Clinical Excellence Commission and shown by this research to be more effective than qSOFA.

Lead author of a paper published in Internal Medicine Journal, Associate Professor Ling Li from the Australian Institute of Health Innovation at Macquarie University, states ASP would have triggered a warning for more than 90% of cases who died in hospital and the warning would have been triggered 8 days before death for half of cases; while in two thirds of cases, qSOFA would have triggered no warning at all before the patient died.

Associate Professor Li explained:

For a patient with sepsis, every hour delay in the commencement of treatment with antibiotics significantly reduces their chance of survival.

“qSOFA has been put forward as an effective tool for early detection of sepsis however our research shows this is not the case and we are calling on all Australian hospitals to use ASP to ensure the best care for patients,” Associate Professor Li said.

Sepsis is a blood-borne infection that triggers a potentially fatal response by the body’s immune system, damaging organs. It effects 20-30 million people worldwide and results in more deaths in Australia than breast or prostate cancer.

Despite advances in care, sepsis remains a huge burden and both ASP and qSOFA were devised to prompt clinicians at a patient’s bedside to consider certain criteria, such as changes in blood pressure, respiratory rate and consciousness, in assessing the possibility of sepsis. This research shows that the use of ASP is more effective for detecting the early warning signs of potential sepsis, improving the patient’s chance of survival.

Both ASP and qSOFA are paper based systems and Associate Professor Li says the future will be in developing automated systems to support clinicians in the early detection of sepsis.

Recently, a team from the Australian Institute of Health Innovation led by Associate Professor Li, completed an evaluation and optimisation of automated clinical systems to improve early sepsis diagnosis and rapid treatment. This research has been adopted by the Clinical Excellence Commission and eHealth NSW for future rollout in NSW.

Clinical Excellence Commission Director of Systems Improvement Dr Harvey Lander welcomed the findings which support the effectiveness of the NSW Sepsis Kills program.

“We welcome findings which demonstrate the pathways being used in NSW, including the new electronic sepsis alert, are highly effective in supporting the early detection of sepsis and therefore improved patient outcomes,” Dr Lander said.

qSOFA was developed by a team from the international Society of Critical Care Medicine and the European Society of Intensive Care Medicine and while not currently widely used in Australian hospitals, it is recommended by the international taskforce of the Third International Consensus Definition for Sepsis and Septic Shock.

This is the first research to compare the effectiveness of ASP and qSOFA and included the analysis of the medical records of 29,000 patients in a large Australian public hospital between 2014-2016.

For further information: Associate Professor Li available for interview, please contact Chrissy Clay on chrissy.clay@mq.edu.au or 0415 292 841. Dr Harvey Lander is also available for interview, please call Sharon Hogan 0434 308 924.

Journal Article: Li L, Rathnayake K, Green M, Shetty A, Fullick M, Walter S, Middleton-Rennie C, Meller M, Braithwaite J, Lander H and Westbrook J. Comparison of the quick Sepsis-Related Organ Failure Assessment (qSOFA) and Adult Sepsis Pathway in predicting adverse outcomes among adult patients on general wards: a retrospective observational cohort study. Internal Medicine Journal. 2020 Jan 6. https://doi.org/10.1111/imj.14746

Acknowledgement: This project was funded by the Clinical Excellence Commission and eHealth NSW. The research was conducted independently of the funding body.

CENTRES RELATED TO THIS NEWS

Centre for Healthcare Resilience and Implementation Science

Centre for Health Systems and Safety Research

FOR FURTHER INFORMATION, PLEASE CONTACT

Chrissy Clay, Research Outreach Coordinator

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