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
Finally, the Shakespeare quote is really not apropos - if you know what you're looking at, who cares what name you give it? The problem with sepsis, is that we don't know what we're looking at, and we're calling tulips carnations, geraniums and every manner of flower a rose. Which led to my tweet this morning: "Perhaps sepsis argot is pure contrivance. Imagine we created a syndromic definition for "acute vascular crisis" and enrolled patients with myocardial infarction, stroke, peripheral or mesenteric ischemia [and every manner of vaso-occlusive disorder.]" Would we expect any useful homogeneity or actionable information to derive from such a syndromic classification of multiple markedly different albeit related underlying diseases?