• Sepsis
• Septic Shock

How was I supposed to know what sepsis was, if my doctor wasn’t thinking about it. Melissa Mead1

William Mead and his family were failed by a health system that ‘lacked understanding of sepsis, particularly in children (Secretary of State for Health)’ (http://http://www.youtube.com/watch?v=Qmw7YfxEIUU). Postmortem review identified a number of ‘missed opportunities’ for an earlier diagnosis and escalation in William's care (http:s//www.england.nhs.uk/south/wp-content/uploads/sites/6/2015/03/root-cause-analysis-wm-report.pdf), and each recommendation proposed by an expert panel, which included William's mother, has been acted on. We now have a National Health Service (NHS) system-wide action plan for improving outcomes in patients with sepsis (https://www.england.nhs.uk/wp-content/uploads/2015/08/Sepsis-Action-Plan-23.12.15-v1.pdf), and tools for medical professionals and parents looking after children (http://sepsistrust.org/wp-content/uploads/2015/08/sepsis-toolkit-FINAL-09151.pdf). In December 2015, the National Medical Director of NHS-England wrote that sepsis care was ‘about ensuring that professionals are supported and equipped to be aware of sepsis, ensuring that they have access to evidence based guidelines, and that they are trained in identifying and treating sepsis promptly.’ (Notwithstanding, of course, the need for a clinical approach that adheres to good antibiotic stewardship.) Now, de Vos-Kerkhof et al2 provide new information that helps with the recognition and identification aspect of this sepsis strategy—but, first, let us consider the context of two recent articles.

Sepsis is a global health problem. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)3 updated previous definitions used in adults and presented a novel approach to using clinical criteria for identifying patients with greater …