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Improving identification of severe sepsis by junior doctors: an observational study


Sepsis is a significant cause of morbidity and mortality worldwide. Early recognition and treatment are of paramount importance in reducing mortality; this has been highlighted by the Surviving Sepsis Campaign (SSC) [1]. A consensus of opinion exists as to Time Zero being the first instance where severe sepsis is present. We undertook a study of newly qualified doctors in a university teaching hospital, to evaluate how effective they were at recognising severe sepsis; and whether a simple intervention could improve their ability to perform this task.


The case file of a patient with septic inflammatory response syndrome leading to severe sepsis was identified and anonymised. Time Zero was identified by the investigators based on the SSC criteria. The case file was distributed to a sample of junior doctors over a 2-month period. They were asked to study the retrospective case record and fill in a questionnaire identifying when they felt Time Zero occurred. These data were collected and then the doctors were given an educational tool about the SSC guidelines and the definition of Time Zero. They were then asked to reappraise the case and reassess the Time Zero point based on their new knowledge.


Thirty junior doctors participated; all had less than 4 months postgraduate experience. Time Zero was correctly identified on the first attempt by 17% (n = 5) of the juniors. Time Zero estimates ranged from -70 to +920 minutes of the actual value. After implementation of the teaching tool, 100% of the doctors correctly identified Time Zero according to the SSC criteria.


These results show that there can be significant discrepancies in the accuracy of prediction of Time Zero, which in turn could have significant implications for the diagnosis and timely inception of treatment in severe sepsis. A simple intervention such as an educational tool based on current SSC guidelines can improve the accuracy and speed of diagnosis, and this may have an effect on morbidity and mortality.


  1. Dellinger RP, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Crit Care Med 2008, 36: 296-232. 10.1097/01.CCM.0000298158.12101.41

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Slattery, M., Hepburn, D., Jagadeeswaran, R. et al. Improving identification of severe sepsis by junior doctors: an observational study. Crit Care 13 (Suppl 1), P346 (2009).

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  • Severe Sepsis
  • Time Zero
  • Timely Inception
  • Case Record
  • Retrospective Case