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Who's really infected anyway? A new tool for retrospectively detecting sepsis in emergency department patients

      Any investigator conducting a sepsis trial has to face a fundamental and vexing methodological problem with no simple fix. There is no definitive way to know for sure which subjects actually have the condition. In medical practice, sepsis is a clinical diagnosis based on a constellation of signs and symptoms coupled with a suspicion for infection as the inciting event. But the problem is that sepsis lacks a diagnostic gold standard test.
      • Cortés-Puch I.
      • Hartog C.S.
      Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights.
      Blood cultures growing pathogenic bacteria –the most unimpeachable marker of infection – are positive only in a minority of suspected sepsis patients.
      • Mellhammar L.
      • Kahn F.
      • Whitlow C.
      • et al.
      Bacteremic sepsis leads to higher mortality when adjusting for confounders with propensity score matching.
      And positive cultures from other sites – such as sputum or urine – cannot reliably distinguish colonization from invasive infection.
      • Jokinen J.
      • Snellman M.
      • Palmu A.A.
      • et al.
      Testing pneumonia vaccines in the elderly: determining a case definition for pneumococcal pneumonia in the absence of a gold standard.
      ,
      • Chu C.M.
      • Lowder J.L.
      Diagnosis and treatment of urinary tract infections across age groups.
      When it comes to treating patients with suspected sepsis, doctors sacrifice specificity for sensitivity so as not to delay early and potentially life-saving treatment. As a result, many patients are presumptively diagnosed with sepsis who later are determined to have non-infectious conditions.
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      References

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        Am J Med Sci. 2022; S0002-9629 (Epub ahead of print): 00080-00085https://doi.org/10.1016/j.amjms.2022.02.008