The Society of Critical Care Medicine is meeting this week, JAMA devoted an entire issue to sepsis and critical illness, and my twitter feed is ablaze with news of release of a new consensus definition of sepsis. Much laudable work has been done to get to this point, even as the work is already generating controversy (Is this a "first world" definition that will be forced upon second and third world countries where it may have less external validity? Why were no women on the panel?). Making the definition of sepsis more reliable, from a sensitivity and specificity standpoint (more accurate) is a step forward for the sepsis research enterprise, for it will allow improved targeting of inclusion criteria for trials of therapies for sepsis, and better external validity when those therapies are later applied in a population that resembles those enrolled. But what impact will/should the new definition have on clinical care? Are the-times-they-are-a-changing?
Diagnosis, a fundamental goal of clinical medicine is important for several reasons, chief among them:
- To identify the underlying cause of symptoms and signs so that treatments specific to that illness can be administered
- To provide information on prognosis, natural history, course, etc for patients with or without treatment
- To reassure the physician and patients that there is an understanding of what is going on; information itself has value even if it is not actionable
Thus redefining sepsis (or even defining it in the first place) is valuable if it allows us to institute treatments that would not otherwise be instituted, or provides prognostic or other information that is valuable to patients. Does it do either of those two things?
