\
December 20, 2012
One Boy’s Death Moves State to
Action to Prevent Others
By JIM DWYER
Prompted by the death of a 12-year-old Queens boy in April, New York health
officials are poised to make their state the first in the nation to require that
hospitals aggressively look for sepsis in patients so treatment can begin sooner.
Under the regulations, which are now being drafted, the hospitals will also have
to publicly report the results of their efforts.
The action by New York has elated sepsis researchers and experts, including
members of a national panel who this month formally recommended that the
federal government adopt standards similar to what the state is planning.
Though little known, sepsis, an abnormal and self-destructive immune
response to infection or illness, is a leading cause of death in hospitals. It often
progresses to severely low blood pressure, shock and organ failure.
Over the last decade, a global consortium of doctors, researchers, hospitals and
advocates has developed guidelines on early identification and treatment of
sepsis that it says have led to significant drops in mortality rates. But first hints
of the problem, like a high pulse rate and fever, often are hard for clinicians to
tell apart from routine miseries that go along with the flu or cold.
“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a
professor at Brown University School of Medicine and a lead author of a paper
on the latest sepsis treatment guidelines to be published simultaneously next
month in the United States in a journal, Critical Care Medicine, and in Europe in
Intensive Care Medicine.
“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills
more people than breast cancer, lung cancer and stroke combined.”
If started early enough, the treatment, which includes antibiotics and fluids, can
help people escape from the drastic vortex of sepsis, according to findings by
researchers working with the Surviving Sepsis Campaign, the global
consortium. The tactics led to a reduction of “relative risk mortality by 40
percent,” Dr. Levy said.
Although studies of 30,000 patients show that the guidelines save lives, “the
problem is that many hospitals are not adhering to them,” said Dr. Clifford S.
Deutschman, director of the sepsis research program at the Perelman School of
Medicine at the University of Pennsylvania and the president of the Society of
Critical Care Medicine.
About 300 hospitals participate in the study, and the consortium has a goal of
having 10,000. “The case is irrefutable: if you take these sepsis measures, and
you build a program to help clinicians and hospitals suspect sepsis and identify
it early, that will mean more people will survive,” Dr. Levy said.
At a symposium in October, the New York health commissioner, Dr. Nirav R.
Shah, said that he would require state hospitals to adopt best practices for early
identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make
it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor.
“The state is taking unprecedented measures to prevent and effectively treat
sepsis in health care facilities across the state and is looking at a wide range of
additional measures to better protect patients,” Mr. Vlasto said.
In April, Rory Staunton, a sixth grader from Queens, died of severe septic
shock after he became infected, apparently through a cut he suffered while
playing basketball. The severity of his illness was not recognized when he was
treated in the emergency room at NYU Langone Medical Center. He was sent
home with a diagnosis of an ordinary bellyache. Hours later, alarming
laboratory results became available that suggested he was critically ill, but
neither he nor his family was contacted. For an About New York column in The
New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly
discussed their son’s final days. Their revelations prompted doctors and
hospitals across the country to seek new approaches to heading off medical
errors.
In addition, Commissioner Shah in New York convened a symposium on sepsis,
which included presentations from medical experts and Rory’s parents.
At the end of the meeting, Dr. Shah said that he had listened to all the statistics
on the prevalence of the illness, and that one had stuck in his memory: “Twenty-
five percent,” he said — the portion of the Staunton family lost to sepsis.
He said he would issue new regulations requiring hospitals to use best practices
in identifying and treating sepsis, actions that, he said, he was taking “in honor
of Rory Staunton.”
The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s
advocacy has been essential to creating a strong public will for action.”
Dr. Levy said New York’s actions were “bold, pioneering and grounded in good
scientific evidence,” adding, “The commissioner has taken the first step even
before the federal government.”
Dr. Deutschman said that initiatives like those in New York were needed to
overcome resistance among doctors. “You’re talking about a profession that has
always prided itself on its autonomy,” he said. “They don’t like to be told that
they’re wrong about something.”
The availability of proven therapies should move treatment of sepsis into a new
era, experts say, comparing it to how heart attacks were handled not long ago.
People arriving in emergency rooms with chest pains were basically put to bed
because not much could be done for them, said Dr. Kevin J. Tracey, the
president of the Feinstein Institute for Medical Research at North Shore-Long
Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major
discoveries about the relationship between the nervous system and the runaway
immune responses of sepsis.
If physicians and nurses were trained to watch for sepsis, as they now routinely
do for heart attacks, many of its most dire problems could be headed off before
they got out of control, he said. The Stauntons have awakened doctors and
nurses to the possibility of danger camouflaged as a stomach bug.
“We are with sepsis where we were with heart attack in the early 1980s,” Dr.
Tracey said.
“If you don’t think of it as a possibility, this story can happen again and again.
This case could change the world.”
E-mail: [email protected]
Twitter: @jimdwyernyt
MORE IN N.Y. / REGION (1 OF 26 ARTICLES)
Storm Weakened a Fragile System for Mental Care
Read More »
Close
