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The Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) redefined sepsis with the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Sepsis is life-threatening organ dysfunction due to dysregulated host responses to infection. Septic shock is a subset of sepsis where underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality [2].

2003 vs 2016 Definitions of Sepsis [1-4]

Systemic Inflammatory Response Syndrome (SIRS) is out.

Includes normal responses to infection (eg. fever and tachycardia is not dysregulated infection; it’s just infection)

SIRS even MISSES up to ⅛ very septic ICU pts (NEJM 2015) [5].

qSOFA is in. a qSOFA score of 2 or 3 or a rise in the SOFA score of 2. The SOFA score requires a ton of lab values so the authors wanted something that could be assessed at triage, hence the quick SOFA score (qSOFA). The authors derived and retrospectively validated this score and compared it to SIRS in a cohort of 148,907 patients [3]

Issues:

Unclear how to interpret studies (EGDT through ProCESS, PROMISE, ARISE) with new definitions.

CMS is not going to adapt.

Not endorsed by ACEP or SAEM as emergency providers were not included.

qSOFA has not been prospectively validated. It’s unclear how it will perform in this fashion

Notes: Sepsis rates have increased over the past 10 years and it appears that mortality has decreased. However, less sick patients are included in this. It appears that the Sepsis 3 authors were hoping for a more specific definition.

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