Cliff Lindeman, Richard Golonka, Doug Klein, Michael K Stickland, John C Spence
Predicting family physician physical activity electronic medical record inputs
Preventive medicine
objective review case definition occurrence outcome sepsis discuss whether epidemiology sepsis changed time discuss issues important understanding sepsis data sources literature review data summary understanding epidemiology sepsis hampered lack reliable case definition inconsistent application sepsis definition criteria contributes confusion variability literature variability time course sepsis also introduces difficulty centers disease control estimated incidence 736 per 100000 population 1979 rising 1759 per 100000 1989 however study septicemia severe sepsis several hospitalbased studies occurrence severe sepsis defined using american college chest physicianssociety critical care medicine consensus criteria studies reported variable hospital intensive care unit icu occurrence rates ranging 2 11 hospital icu admissions data academic tertiary care centers limits generalizability populationbased studies required better delineate incidence risk factors sepsis general population hospital mortality sepsis ranged 25 80 last decades although mortality may lower recent years sepsis clearly still serious condition achieving better understanding whether mortality rate sepsis falling however confounded lack uniform definition risk factors adverse outcome include degree physiologic derangement organ dysfunction underlying illness site infection microbiological etiology know however factors predict response new therapies dilemma led researchers explore whether markers inflammatory cascade might specific sepsis accurate risk prediction useful predicting response therapy however yet equivalent cpkmb acute myocardial infarction whether find marker develop greater understanding genetic control inflammatory cascade uncertain promising one might assume intuitively epidemiology sepsis changing example number patients treated icus increased time technologies used icu changed choice use antibiotics changed predisposing factors chemotherapeutic regimens also changed marked changes antibiotic resistance furthermore wide changes microbiological etiologies diseases pneumonia acute exacerbations chronic bronchitis however lacking good case definitions true incidence studies make inferences whether epidemiology sepsis truly changing conclusion many studies documented many aspects epidemiology sepsis however composite picture provide although rich many aspects remains incomplete emphasizes heterogeneity condition unfortunately populationbased prospective cohort studies exist allow us accurately delineate risk factors sepsis course outcome place new information role genetic predisposition correct context essential studies conducted