An interesting paper from the new Lancet Primary Care journal. Citation, summary, extracts and comment from me below.
CITATION: Preventing, identifying, and managing sepsis in the community: research and clinical priorities
Rudd, Kristina E et al.
The Lancet Primary Care, 2025, Volume 1, Issue 1, 100010
https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(25)00010-X/fulltext
SUMMARY
Sepsis, defined as life-threatening acute organ dysfunction due to infection, is generally considered a hospital-based issue. However, sepsis usually begins in the community, where knowledge of sepsis is scarce, diagnosis is difficult, and resources vary. Community-based interventions might offer the best opportunity for prevention, prompt diagnosis, and improved outcomes. In this Viewpoint, we address current gaps and limitations in understanding of sepsis in the community and outline research priorities, clinical priorities, and existing initiatives across four domains: mitigation (ie, reduction of population-based sepsis risk), monitoring (ie, screening for sepsis in individuals at high risk of sepsis), measurement (ie, identification of sepsis in the community), and management (ie, treatment of sepsis in the community). We propose a pathway to improve the care of individuals with, or at risk of, sepsis in the community and delineate the next steps to advance the field.
EXTRACTS
'During the period from symptom onset to hospital presentation for sepsis, treatability declines. Survival rates decline once multiorgan failure and shock develop, even with optimal hospital-based care.11 Furthermore, among patients who survive, more severe manifestations of sepsis result in worsened long-term morbidity.12 However, for various reasons, many individuals are not diagnosed with sepsis until clinical manifestations are advanced. Awareness of sepsis signs and symptoms among both the public and clinicians lags behind other time-sensitive medical emergencies, such as myocardial infarction or stroke.'
'Although signs and symptoms of myocardial infarction or stroke often prompt urgent health-care evaluation, signs and symptoms of sepsis often do not elicit this same sense of urgency. People might delay presentation to health-care systems because of a lack of awareness, inadequate access to transportation or health-care facilities, social or financial vulnerabilities, fear of missing work or other duties, cultural beliefs, distrust of medical systems, or dismissal because they were dismissed after seeking evaluation earlier in the disease course when symptoms were milder.14 In settings without universal affordable health care, patients, families, and communities often experience substantial financial burdens when deciding whether to seek medical care. Therefore, understanding the care-seeking behaviours and addressing barriers to timely evaluation across contexts, particularly in resource-variable settings and LMICs, are essential.'
COMMENT (NPW): Do the above observations fit with your experience? We invite comments from all groups, especially primary health workers in the commmunity: community health workers, nurses, midwives and doctors. What can be done to reduce mortality and morbidity from sepsis in adults? and in children?
Best wishes, Neil
HIFA profile: Neil Pakenham-Walsh is coordinator of HIFA (Healthcare Information For All), a global health community that brings all stakeholders together around the shared goal of universal access to reliable healthcare information. HIFA has 20,000 members in 180 countries, interacting in four languages and representing all parts of the global evidence ecosystem. HIFA is administered by Global Healthcare Information Network, a UK-based nonprofit in official relations with the World Health Organization. Email: neil@hifa.org