Gaining Ground in the Fight Against Sepsis

This Sepsis Awareness Month brings confirmation that Martha’s Rule, a route to a second medical opinion for patients and families – campaigned for by the family of Martha Mills who died from sepsis at age 13 – will now be extended to all hospital emergency departments by March 2028.

This follows closely on NHS England’s new framework, published in July, which outlines a ten-year vision to transform sepsis care. In addition, there are reports this month of the possibility that a new blood test may be able to identify sepsis more quickly.

In the light of this, I consider here the growing scale and causes of sepsis, diagnosis and treatment challenges, recent advances and when medical negligence claims can arise.

Sepsis is a life-threatening condition caused by the body’s response to infection. It can result in significant damage to tissues and organs, leaving survivors with very significant disabilities. It is well recognised that speed is paramount when managing the condition since as time elapses more cells are ‘attacked’. According to the NHS, for every hour of delayed treatment the risk of death increases by up to eight percent. When healthcare professionals fail to recognise warning signs or treatment is delayed, the consequences are often catastrophic.

According to estimates from the UK Sepsis Trust, the condition affects about 245,000 individuals across the UK each year and is a contributing factor in around 48,000 deaths. Sepsis may also be on the rise with another recent study concluding that ‘the recorded incidence of sepsis-coded hospital admissions has risen.’

A striking characteristic of sepsis is that virtually any infection can act as a trigger. Bacterial infections are the most common cause, including chest infections, urinary tract infections, infected skin wounds and abdominal conditions such as appendicitis.

Anyone can get sepsis. Babies under 12 months, very young children and the elderly are at an increased risk. Also at higher risk are people on immunosuppressive treatments, such as some cancer patients; those with diabetes or other serious or chronic illnesses; pregnant women; and people with indwelling medical devices or surgical wounds.

Because sepsis develops very quickly it is extremely important to be aware of the symptoms and seek medical help as an emergency. These symptoms include difficulty breathing, a high or low temperature, blue, grey, pale or blotchy skin, lips or tongue, and not having urinated all day. In adults there may be slurred speech and/or confusion as well as muscle pain and uncontrolled shivering. Children may also be sleepy or hard to wake, may have fits and can have a rash that does not fade when pressed. (This is uncommon in sepsis but may be a symptom of meningitis).

Diagnosis of sepsis

According to the National Institute for Health and Care Excellence (NICE), upon presentation to hospital, medical staff should use the National Early Warning Signs (NEWS2) parameters when considering sepsis in those over 16. This clinical scoring system monitors six vital indicators: respiratory rate, oxygen saturation, systolic blood pressure, pulse rate, level of consciousness, and temperature. A patient found to be at high risk should receive broad-spectrum intravenous antibiotic treatment within one hour of assessment. The source of the infection must be investigated and once confirmed a more specific antibiotic may be required. Depending on how far the condition has advanced, further treatments beyond antibiotics may be necessary and severe cases can require surgical amputations to remove infected tissue or limbs.

A major challenge is identifying the specific pathogen responsible for the infection quickly enough. Researchers in Scotland and Germany report that they have found that a new blood-based DNA sequencing test has been able to identify likely sepsis pathogens days before conventional methods. The new test is said to work by detecting fragments of microbial DNA circulating in a patient’s blood, as opposed to needing to wait for bacteria or other organisms to grow in a laboratory culture.

Having experience of the catastrophic damage that can be caused by delays in treating sepsis, both from my earlier career as a nurse and my extensive experience as a medical negligence lawyer, this advancement clearly could be very significant.

Also significant should be the future introduction via the NHS sepsis framework of wearable devices for people at risk of sepsis to monitor their vital signs at home, automatically flagging if a person’s condition has deteriorated and they need to be tested for sepsis.

Medical Negligence

The challenges around the condition, the fact that it can present similarly to other illnesses (such as influenza) and the speed with which treatment must be provided means that sepsis is an area in which a significant number of claims for medical negligence are made each year.

Cases are often complex, particularly in terms of proving what difference earlier treatment would have made. This usually requires input from experts in microbiology and other disciplines. For those seriously injured, claims can be very significant.  For example, where a patient has lost limbs claims will include compensation for care, accommodation, therapies and prosthetics. These claims need a specialist lawyer to thoroughly investigate and assess the compensation needed, especially considering how needs may fluctuate over time.

Tragically, patients may lose their lives as a result of mistreatment of sepsis, and this may give rise to a claim on behalf of their estate and on behalf of their dependants.

Some patients’ recovery is complicated by post-sepsis syndrome (PSS) which can cause multiple symptoms. These include feeling very tired, suffering hearing loss, nerve damage, depression, and cognitive problems (such as memory loss and finding it difficult to concentrate). For those bringing a legal claim, the possible impact of PSS requires careful consideration.

Martha’s Rule

We have written several articles on the inception and progress of Martha’s Rule which can be accessed here:

• Acclaim for Martha’s Rule – but when will maternity services be included?
• Martha’s Rule – it will be vital for patients to know about this new route to an emergency second opinion
• Another young death highlights the need for Martha’s Rule
• Sepsis claims and ‘Martha’s Rule’

If you are concerned about the treatment received by yourself or a loved one, please do not hesitate to contact our supportive and friendly team for a no obligation discussion.