Sepsis: the importance of rapid treatment in the ‘golden hour’

Posted: 04/07/2024

A student who died in hospital after her sepsis infection went unnoticed ‘wasn't listened to in screams of pain’, according to media reports, which stated that Maddy Lawrence, 20 years old, was playing rugby when she was injured after being tackled. She dislocated her hip and was taken to Southmead Hospital in Bristol, but died just over two weeks later from multiple organ failure, after staff missed the crucial window to treat sepsis. Tragically her story is not uncommon. 

The statistics relating to sepsis are frankly frightening. It is quoted that every three seconds, someone in the world dies of sepsis. In the UK alone, 245,000 people are affected by sepsis, with at least 48,000 people losing their lives in sepsis-related illnesses every year. This is more than deaths from breast, bowel and prostate cancer combined. Globally, sepsis claims 11 million lives a year.

What is sepsis?

There seems to be confusion as to what sepsis is and how it occurs. Sepsis is not a form of infection as some think, but instead the body’s own response to infection. It occurs when the immune system has a dangerous reaction to an infection and causes extensive inflammation throughout the body that can lead to tissue damage, organ failure and even death. 

Any type of infection can lead to sepsis, including bacterial, viral or fungal infections. Those that more commonly cause sepsis include infections of the lungs (such as pneumonia), the kidneys, bladder and other parts of the urinary system. If organisms get into the blood, then the conditions of bacteraemia (the presence of organisms in the blood) or septicaemia (organisms multiplying in the blood) occur. There is hypotension, pyrexia, rigors, and an obvious source of infection. Septicaemia can progress to renal involvement, circulatory collapse (septic shock) and, in later stages, intravascular coagulation defects. The condition has an extremely high mortality rate. 

Commonly in sepsis there is a preceding relatively minor illness, but in some susceptible patients for reasons as yet not fully understood, sepsis can then take hold. In septic shock the patient becomes rapidly and seriously ill within a matter of minutes or hours, with reduced blood pressure, tachycardia, vasoconstriction, cardiac depression, pulmonary oedema, and hypoxia. The patient becomes cold, clammy, drowsy, with a high heart rate and critically ill.

The symptoms of sepsis can develop quickly and include a high temperature, chills and shivering, increased heart rate and rapid breathing. As the condition progresses to septic shock, the patient may feel dizzy or faint, be confused or disorientated, have slurred speech, diarrhoea, nausea and vomiting, muscle pains, breathlessness, decreased urinary output, and be cold, clammy and pale with mottled skin and loss of consciousness.  

Sepsis is a serious medical emergency and requires emergency admission to hospital. Treatment is with fluid replacement, aggressive intravenous antibiotics, and steroids. NICE, the National Institute for Health and Care Excellence, urges hospital staff to treat people with life-threatening sepsis within one hour, in its quality standard. In clinical practice, this is often referred to as the 'golden hour' after diagnosis.

In 2012 the UK Sepsis Trust was established as a charity to highlight the issues both with regard to public awareness and NHS management.

Case study

Our clinical negligence team has significant experience of investigating claims arising from delayed diagnosis of, and treatment for, sepsis, and the tragic consequences that can have. One ongoing case relates to a GP’s failure to suspect a developing systemic illness and refer our client, a man in his 20s, to hospital for urgent investigations and treatment. With earlier treatment he would have made a full recovery after a short period in hospital, and would not have needed the four months in hospital on life support, or suffered the permanent injuries, including lung damage and losing his fingertips and toes, that actually occurred. 

To begin with, there was a negligent failure by the GP to realise that our client was systemically unwell, and to take his temperature, pulse, and blood pressure. Our independent experts have advised that had our client been examined, that examination would have revealed a significantly elevated heart rate and a fever (an abnormally high temperature). On realising this, for an immunocompromised patient as our client was, any reasonably competent GP would have referred him urgently to hospital for further evaluation. At hospital, it would have been realised that our client had significantly raised inflammatory markers and an early acute kidney injury. He would have been admitted to hospital and his sepsis, and then pneumonia, would have been diagnosed. 

With in-patient hospital monitoring and treatment for his sepsis and pneumonia, our client would probably have recovered with fluid therapy and antibiotics alone. He would still have had to recover from a severe infection; however, he would have been discharged home after around a week in hospital, and would have made a full recovery. 

Alison Johnson, partner in the clinical negligence team, comments that this is a tragic case where our client was indeed lucky to survive. She says: “With an earlier referral to hospital for sepsis treatment to commence promptly, our client would have avoided an acute, very painful and distressing deterioration, during which time he was admitted to hospital by an emergency ambulance, and his extended family were summoned to hospital to be told that he ‘might deteriorate and die’. He would have avoided four months of hospital treatment, including over three months in an induced coma on life-support treatment, renal replacement therapy and mechanical ventilation. He wouldn’t have developed such significant weakness as he did, as a result of his lengthy intensive care stay, such that he required help with mobilising, washing, toileting and meal preparation once discharged home from hospital. Our client wouldn’t have suffered reduced lung capacity nor developed necrosis in his fingertips and toes, some of which he has lost, leaving him with poor balance and reduced dexterity.” 

Alongside his physical injuries, what our client has gone through has understandably had a huge impact on his mental health. He has lost the ability to undertake manual work and his relationship has broken down. The clinical events have had a life-changing impact on our client, physically, emotionally and financially. His claim is pleaded at approximately £2.5 million. 

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