Table 2 Summary of explanations for why cases were not diagnosed as severe sepsis/septic shock
From: Diagnosing sepsis is subjective and highly variable: a survey of intensivists using case vignettes
No infection or organ dysfunction | Infection but organ dysfunction not present or not severe enough to qualify | Organ dysfunction but no infection | Infection and organ dysfunction, but not attributable to infection | Misclassifieda | No explanation given | Representative quotes | |
|---|---|---|---|---|---|---|---|
Case A (pneumonia, heart failure, respiratory failure, and shock) | 0 | 0 | 23 | 16 | 0 | 9 | “Sounds like cardiogenic shock. Although heart rate and white blood cell count would meet SIRS criteria, this does not appear to be inflammatory in etiology. The mixed organisms are unconvincing for a true infection.” |
Case B (pyelonephritis, acute kidney injury) | 0 | 36 | 0 | 2 | 0 | 10 | “SIRS (3/4 – temperature, heart rate, and white blood cell count) plus documented infection so sepsis. Although she had some degree of renal dysfunction, it resolved with fluids and antibiotics, so I would not classify her as severe sepsis.” |
Case C (colitis, hypotension) | 8 | 22 | 4 | 11 | 1 | 14 | “She’s tachycardic, has low grade fever, hypotension, mild acute kidney injury, and CT evidence of colitis, so this seems related to infection, but she gets better with fluids and antibiotics quickly, with a high normal lactate that normalized rapidly, so no shock.” |
Case D (COPD exacerbation, respiratory failure) | 9 | 26 | 5 | 9 | 0 | 16 | “COPD exacerbation with suspected source of infection, but no hypotension or lactate elevation.” |