First Recognition, Then Education
Recognition bundles stress the importance of an early diagnosis of severe sepsis and septic shock, a fundamental step in the treatment process since its outcome is closely related to timely care. Nonetheless, the first symptoms of sepsis start at the patient’s home, with caretakers responsible for the recognition of red flags. In France, Launay et al (2) concluded that suboptimal care of bacterial severe disease has a negative global effect on survival and described that the main causes of suboptimal care were related to the caretakers delay in recognizing the need for medical assistance (20%) and to an underevaluation of severity of disease by the physician (20%).
In a survey made by World Federation of Pediatric Intensive Care and Critical Care Societies, the major barriers of treatment were lack of parental recognition of sepsis and failure of referring centers to diagnose sepsis by more than 50% of respondents (3).
The recognition bundle also helps on early detection of clinical features of sepsis, severe sepsis, and shock septic that are common to other diseases such as bronchiolitis, asthma, pancreatitis, and burns leading to difficulty to apply then on clinical practice. Weiss et al (4) showed in the Sepsis PRevalence, OUtcomes and Therapies (SPROUT) study that there were 43% of discordance between physician diagnosis and the 2005 International Pediatric Sepsis Consensus Conference criteria. This suggests that it is difficult to apply the criteria without a guidance. The American Academy of Pediatric trigger tool for early septic shock recognition simplifies the diagnosis by searching for abnormalities on blood pressure, pulse, mental status, capillary refill, skin, temperature, heart rate, and respiratory rate.
The inclusion of sepsis as one of the world’s health priorities is a major step toward fostering education. At the 70th World Health Assembly, held in Geneva, in May 2017, the document entitled “Improving the prevention, diagnosis and treatment of sepsis” was approved as a result of the work of the Sepsis Global Alliance. The document asks for the Member States to include in their agendas: 1) to increase public awareness of the risk of infectious diseases progressing to sepsis through education and 2) to develop training for health professionals on the importance of the recognition of sepsis as a possible condition and critical relationship with time and with urgent therapeutic needs (5).
In this way, we believe that the next step should be the population education about sepsis including its early signs and when parents should search for help.