Melissa M Hanson1
1 Emergency Department, Dubbo Base Hospital, Myall Street, Dubbo, N.S.W. 2830, firstname.lastname@example.org
The New Sepsis 3.0 poster aims to educate ED clinicians regarding the new sepsis definitions set out by the Third International Consensus Definitions for Sepsis and Septic Shock (TICDSSS) (2016), also known as Sepsis 3.0. By adding the new Sepsis 3.0 criteria to the already implemented Adult Sepsis Pathway (ASP) guidelines, it is hoped that sepsis knowledge, recognition, and treatment within Australian EDs might be improved through the presentation of new, easy to read and understand information.
The New Sepsis 3.0 poster describes the new definitions for sepsis and septic shock as defined by the TICDSSS. It also discusses why the term ‘Systemic Inflammatory Response Syndrome’ (SIRS) is now not used – the research supporting the new criteria demonstrates a link between patients admitted to critical care units with infection and new organ failure, and not meeting the SIRS criteria, and thus the inefficacy of the SIRS definition. In place of SIRS are two different sets of clinical criteria that reflect a reliable predictor of mortality – the Sequential (Sepsis-related) Organ Failure Assessment score (SOFA), and the Quick Sequential Organ Failure Assessment score (qSOFA). These scores are presented in the poster in conjunction with humorous puns, eye-catching images and matching, easy-to-remember mnemonics.
The New Sepsis 3.0 poster does not just list information – it challenges its viewers to think critically. It effectively asks the viewer, “What do you think?” For example, facts are presented that compare and contrast the SIRS criteria to the SOFA and qSOFA criteria, and the resulting outcome of mortality. Importantly, the literature discovered that within the ED environment, the qSOFA score has a greater validity for predicting mortality rate than the SOFA score, and thus the poster makes mention of the importance of qSOFA to EDs. In addition to this, some of the limitations of the Sepsis 3.0 criteria are listed, but not all, because the aim of the poster is to encourage clinicians to go back and perform their own additional research in order to make their own decision. That is why the heading at the top of the poster asks, “Which side of the sofa are you sitting on?” The poster also makes clinicians question the specificity of what is presented. For example, the SOFA and qSOFA scores may result in earlier recognition of patients who are at risk of sepsis, but this may also lead to unnecessary admissions and treatments in some patients. The specificity is not designed in the SOFA and qSOFA scores to differentiate between, for example, those patients who score a positive result in the qSOFA score, but comparatively low on a prognostic pneumonia scoring scale. These patients may be over-treated as a result, with prolonged and unnecessary stays in critical care units. Each definition and scoring criteria for sepsis, both the old and the new ones, will have its positive and negative aspects – it is up to the clinicians and their departments to research, validate evidence, and subsequently decide which criteria is best for their department and patients.
References for the poster:
 Singer, M., Deutschman, C. S., Seymour, C. W., Shankar-Hari, M., Annane, D., Bauer, M., . . . Angus, D. C. (2016). The third international consensus definitions for sepsis and septic shock (Sepsis-3). Journal of the American Medical Association, 315(8), 801-810. http://dx.doi.org/10.1001/jama.2016.0287
 Abraham, E. (2016). New definitions for sepsis and septic shock: Continuing evolution but with much still to be done [Editorial]. Journal of the American Medical Association, 315(8), 757-759. http://dx.doi.org/10.1001/jama.2016.0290
 Farkas, J. (2016, February 29). PulmCrit—Top ten problems with the new sepsis definition [Blog post]. Retrieved from http://emcrit.org/pulmcrit/problems-sepsis-3-definition/
 Rezaie, S. (2016). Sepsis 3.0 [Blog post]. Retrieved from http://rebelem.com/sepsis-3-0/
 Edmonds, M. (2016). Sepsis 3.0 and the Quick SOFA [Blog post]. Retrieved from http://adelaideemergencyphysicians.com/2016/02
Melissa Hanson is an Advanced Clinical Nurse working in the Emergency Department of Dubbo Base Hospital. She has a passion for resuscitation, sepsis, and critical care. She is currently completing her Masters Degree in Emergency Nursing, and has extensive experience in Emergency Nursing within the Sydney West LHD and Western NSW LHD. Melissa is married to police officer Scott, and they have 3 children aged 4-and-under together. In her down time, she can be found at work, buried in journal articles, or out on the family farm!