Sepsis is "a life-threatening condition that arises when the body's response to an infection injures its own tissues and organs, with the immune system going into overdrive". This is according to The UK Sepsis Trust, which reports there are five deaths an hour due to sepsis in the UK and 48,000 deaths each year related to the condition.

A failure to diagnose sepsis that results in a delay in treatment can have devastating consequences for patients, leading to shock, multi-organ failures and death. It's important for sepsis to be considered as a potential cause in an unwell patient presenting with certain non-specific symptoms.

Diagnosis can be challenging as there is no single sign or symptom to distinguish sepsis from other illnesses and patients may have non-specific, non-localised symptoms. They may not have a high temperature but may, for example, have a change in their usual behaviour.

Consequences for doctors of missing a diagnosis

The MDU undertook an analysis of all cases where sepsis was a feature during 2024. During that period, there was a total of 159 cases reported to the MDU by members who needed advice or assistance.

Of these cases, the majority - at nearly two-thirds (60%) - were requests for support with a coroner's inquest investigating the death of a patient with sepsis. Of those, over half related to care provided in general practice. The remainder involved hospital doctors from a wide range of specialities:

• urology 16%
• general surgery 15%
• internal medicine 14%
• emergency medicine 14%.
• gastroenterology 13%
• paediatrics 9%
• rheumatology 7%
• obstetrics and gynaecology 4%
• anaesthetics 4% and
• radiology 4%

The second most common category related to complaints, which featured in over a quarter of cases (28%). The majority of these (74%) related to care provided in general practice.

There were a small number of claims for clinical negligence, with an equal number arising from care provided by GPs and hospital doctors. These related to delayed diagnosis of sepsis that led to the patient being harmed - for example, amputation of a limb.

In 15% of cases involving hospital doctors, no claim or complaint had been made, but the hospital had instigated a significant event investigation following a delayed diagnosis of sepsis.

Of the 159 cases, two GPs and one hospital doctor were referred to the GMC by the complainant. Again, these cases related to concerns about a delayed diagnosis. After obtaining an expert opinion, which recognised the difficulty in making the diagnosis in these cases, the GMC closed their investigations with no further action.

Risk factors

Sepsis can affect anyone, of any age, but tends to affect the very young (under one year old), the elderly (over 75 years) or those with chronic diseases that make them more vulnerable to infection.

Cases reported to the MDU commonly involved patients suffering from sepsis who had an impaired immune system. This was either due to an underlying condition or to medication they were taking, such as chemotherapy or immunosuppressants for non-malignant conditions like rheumatoid arthritis.

Another common scenario was sepsis resulting post-operatively particularly in relation to procedures on the gastrointestinal or urinary tract. Infection and sepsis in pregnant patients and neonates were rare, but there were a small number of inquests relating to deaths in these groups of patients.

Delays in diagnosing sepsis

A delayed or missed diagnosis of sepsis was the main reason for concerns being raised by patients or their families. In some cases, concerns centred on the patient or the family feeling they weren't listened to when they raised concerns about the patient's condition and how unwell they were.

Guidance and advice

NICE guidance on suspected sepsis covers the recognition, diagnosis and early management of suspected sepsis. If patients have an infection, it is always possible that they could have sepsis or would go on to develop it. NICE recommends that sepsis is considered in patients who present with symptoms or signs indicative of infection.

If you are concerned about infection and sepsis, which may not be immediately obvious, tailor your investigations to finding the source. This could include urinalysis, relevant blood tests and chest x-ray.

Consider any relevant information from the patient's clinical history or risk factors. Several of the cases reported to the MDU involved elderly frail patients who were unwell with non-specific symptoms.

Some patients were also bedbound and were later to found to have infected pressure sores or cellulitis. Other cases included urosepsis secondary to undiagnosed urinary tract infections or sepsis because of pneumonia.

In summary

Sepsis can be a challenging diagnosis to make, so it's important to have a low threshold for considering a diagnosis.

If you're an MDU member involved in an incident, contact us as soon as possible so we are in the best position to advise you on how to respond.