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Preventing, identifying, and managing sepsis in the community: research and clinical priorities
Kristina E Rudd1, Adrienne G Randolph1, Derek C Angus1
1Center for Clinical Research, Investigation, and Systems Modeling of Acute Illness, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA (K E Rudd MD, Prof D C Angus MD); Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA (Prof A G Randolph MD); Department of Anaesthesia, Harvard Medical School, Boston, MA, USA (Prof A G Randolph); Department of Pediatrics, Harvard Medical School, Boston, MA, USA (Prof A G Randolph); Department of Anaesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany (Prof M Bauer MD); Division of Pulmonary, Allergy and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA (C F Chesley MD); Palliative and Advanced Illness Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA (C F Chesley); Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA (C F Chesley); Department of Emergency Medicine, Harvard Medical School, Boston, MA, USA (M R Filbin MD); Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA (Prof G Jenq MD, H C Prescott MD); Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA (J A Kempker MD); Watson Institute for International and Public Affairs, Brown University, Providence, RI, USA (Prof A C Levine MD); Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA (Prof A C Levine); Department of Emergency Medicine, Wayne State University, Detroit, MI, USA (Prof P Levy MD); Intensive Care Department, Hospital São Paulo, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil (Prof F R Machado MD); Departments of Emergency Medicine, Anesthesia, and Epidemiology, University of Iowa Carver College of Medicine, Iowa City, IA, USA (Prof N M Mohr MD); Sepsis Scout, San Francisco, CA, USA (R Quinn PhD); CytoVale, San Francisco, CA, USA (R Quinn); Intensive Care National Audit and Research Centre, London, UK (Prof K Rowan PhD); Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK (Prof K Rowan); Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK (Prof M Shankar-Hari PhD); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada (F Sheikh MSc); Weissman School of Arts and Sciences, Baruch College, City University of New York, New York, NY, USA (P Sleboda PhD); Families Fighting Flu, Prospect, KY, USA (J S Teichman MD); Service of Immunology and Allergy, Center of Human Immunology Lausanne, Department of Medicine and Department of Laboratory Medicine and Pathology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland (Prof T Calandra MD); VA Center for Clinical Management Research, Ann Arbor, MI, USA (H C Prescott).
Abstract:
Sepsis, defined as life-threatening acute organ dysfunction due to infection, is generally considered a hospital-based issue. However, sepsis usually begins in the community, where knowledge of sepsis is scarce, diagnosis is difficult, and resources vary. Community-based interventions might offer the best opportunity for prevention, prompt diagnosis, and improved outcomes. In this Viewpoint, we address current gaps and limitations in understanding of sepsis in the community and outline research priorities, clinical priorities, and existing initiatives across four domains: mitigation (ie, reduction of population-based sepsis risk), monitoring (ie, screening for sepsis in individuals at high risk of sepsis), measurement (ie, identification of sepsis in the community), and management (ie, treatment of sepsis in the community). We propose a pathway to improve the care of individuals with, or at risk of, sepsis in the community and delineate the next steps to advance the field.
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