The equivalent of the population of the Co Cork town of Bantry – 3,000 people – are dying of sepsis every year, according to the lead author of a new guide for GPs on the disease.
It is the leading cause of death in Ireland with more than 15,000 cases a year, and almost 20 per cent of these patients die from the disease. “It can affect any of us at any time,” said Dr Ellen Hayes of the Irish College of GPs.
While sepsis is a particular risk in acute hospitals it is estimated up to 80 per cent of cases arise in the community so “GPs have unique opportunity but face unique challenges for prompt recognition and referral of patients with suspected sepsis”, she said. It mostly affected people “at the extremes of age – children and small babies and particularly people over 75″.
Sepsis is an abnormal immune response; infections most commonly associated with it are found in the lungs, urinary tract, skin and stomach. While doctors have no definitive diagnostic test the new practice “update” issued by the Irish College of GPs comes with an algorithm to help GPs speed up identification of possible cases. It is a tool to assist doctors but does not replace clinical judgment, said Dr Hayes.
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Speaking at a briefing, she said early indications can be quite subtle with mild symptoms that often mimic other conditions like flu. She acknowledged the impact on patients and families: “It is a leading cause of death but also debilitating psychological symptoms which exist beyond hospital discharge.”
Ireland has seen a series of high-profile deaths linked to sepsis, including the death of 16-year-old Aoife Johnston at University Hospital Limerick (UHL) in 2022. A report by retired judge Frank Clarke found nurses and doctors at UHL in the area where Ms Johnston was being treated were “unaware” of the risk of sepsis facing her.
Mr Clarke found there was an almost 14-hour gap between her presentation at hospital and treatment despite being seen by a GP who queried the possibility of sepsis and a nurse identifying the risk of sepsis. The national protocol followed by hospitals suggests treatment should take place within one hour.
The new advice highlights the need for people to get vaccinated for a range of conditions such as flu – especially older people or those with compromised immune systems – as this is the most effective way to reduce cases.
HSE chief clinical officer Dr Colm Henry said the new advice was “a significant milestone” that would assist GPs. The problem must also be seen in the context of antimicrobial resistance and over-prescription of antibiotics which meant infections, especially sepsis, were often more difficult to treat.
He said for GPs the challenge of identifying sepsis is harder than in hospital settings because of much more common conditions that mimic the disease. The focus is on “early recognition; early intervention”.
It’s important for people to know and recognise symptoms that are signs of sepsis and then go and see a doctor urgently, the Irish College of GPs advises.
“The signs really are very common and they’re often very non-specific and vague and are similar across children and adults. So it can be a little bit different,” its medical director, Dr Diarmuid Quinlan, told RTÉ's Morning Ireland
With children, symptoms can include a high-pitched cry; being irritable, often very agitated, confused, sluggish and hard to wake, he said. Other symptoms include cold hands, cold feet, blotchy skin and decreased feeding.
Sometimes people can have severe muscle pain, particularly in the legs, and have difficulty walking. “They can breathe very fast or have difficulty breathing ... people can have a high fever or can have chills and shivering headaches and vomiting.”
People with chronic conditions were also susceptible, including those with diabetes; liver disease, heart disease, also those on certain medications – particularly steroids and immunosuppressants. People who’ve had recent surgery are also more likely to get sepsis, he added.
“With an increasing ageing population there are substantially more people who are at risk of developing sepsis so there are unique challenges – and unique opportunities for GPs – in the early detection of sepsis,” Dr Quinlan added.
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