New Criteria for Sepsis Promise Improved Outcomes

Each year more than one million Americans are stricken by sepsis, 28-50% of whom die from the underlying infection. This week, the Society of Critical Care Medicine published a new definition of septic shock and new criteria for identifying sepsis, with the aim of helping physicians identify patients with, or at high risk of developing, sepsis earlier on. As with most things in medicine, earlier identification means more opportunities for potentially life-saving treatment.

Previously, sepsis was defined as infection accompanied by the Systemic Inflammatory Response Syndrome, characterized by a high heart and respiratory rate, high white blood cell count, and fever. The new criteria, officially called the Quick Sepsis-Related Organ Failure Assessment Score (qSOFA), requires:

  • Positive identification of infection
  • At least two out of three “quick measures” (altered mental status, tachypnea, systolic hypotension)
  • At least two positive organ failure assessment points

In particular, the SCCM expects that an emphasis on “quick measures,” rather than blood tests, will allow for more prompt identification of patients likely to become septic.

Furthermore, the SCCM has identified two criteria to aid physicians in identifying septic shock – a more severe form of sepsis accompanied by a greater risk of complications and mortality:

  • Persistent hypotension with the inability to achieve a mean arterial pressure at or above 65mmHg without the use of vasopressors
  • High blood lactate, even after fluid resuscitation (this criterion is new).

This new definition was applied in recent research based on the electronic medical records of more than 148,907 patients with suspected infection from hospitals around the world. The study debunked old criteria, the SIRS score, as the best measure of sepsis, and favored the new criteria instead.

Article: New Recommendations Aim to Redefine Definition and Enhance Diagnosis of Sepsis, Septic Shock

New Criteria for Sepsis Promise Improved Outcomes

New CDC Alcohol Guidelines for Women Under Fire

Last week, the CDC released guidelines advising all reproductive-age women who are not on birth control to avoid alcohol, with the aim of preventing Fetal Alcohol Syndrome. These new guidelines were based on studies that found that many U.S. pregnancies, more than half of which are unplanned, were at risk for inadvertent alcohol exposure, as many women continue to drink while trying to conceive, and may not realize when they are pregnant.

Commentators widely decried the new guidelines as offensive to women for many reasons, claiming that the mandate was condescending, strangely silent on men’s role in conception, heteronormative, and propagating an outdated view of women as solely reproductive entities. Not to mention, some dismissed the mandate as simply unrealistic. In the face of such widespread criticism, the CDC recently came forward in defense of its advice, but at the same time admitted that its attitude toward women may have been “misunderstood” or imprecisely expressed.

 

Article: Women Blast CDC’s Advice To Use Birth Control If Drinking Alcohol

New CDC Alcohol Guidelines for Women Under Fire

Screen All Women for Depression During and After Pregnancy

Last week, a panel appointed by the US Preventive Services Task Force recommended screening all pregnant women for depression – even if they don’t have any recorded risk factors. The USPSTF’s new guidelines accompany a growing field of research on maternal mental illness supporting the hypothesis that “postpartum” depression in fact often begins during – not after – pregnancy. Their recommendations are more than just suggestions: the task force gave the new guidelines a “B” rating, meaning that the screening must be covered under the Affordable Care Act.

The American Congress of Obstetricians and Gynecologists previously recommended screening for perinatal depression, but emphasized that screening alone was not sufficient, and needed to be accompanied by systems in place to provide adequate mental health care and treatment. Despite the traditional recommendation that health care organizations should not screen for a condition they are not prepared to treat, these new guidelines recommend screening for depression even when such systems aren’t in place, citing the relatively increased availability and acceptance of mental health care in our medical system.

 

Article: Panel Calls for Depression Screenings During and After Pregnancy

Screen All Women for Depression During and After Pregnancy