There are significant differences between the way the United States and Europe take care of patients with severe sepsis and septic shock, according to a study in The Lancet Infectious Diseases.

Severe sepsis is a potentially fatal illness which results from an over-reaction of the immune system to an infection, which may progress into septic shock. The body’s essential organs then become disrupted and a hazardous drop in blood pressure is seen.

Each year, there are about 30,000 cases of severe sepsis in the UK. While the number appears to be increasing, unfortunately, death is the end result of an estimated 30% to 50% of severe sepsis patients. According to previous research, sepsis is the leading cause of death in U.S. hospitals, with 750,000 patients and over 250,000 deaths each year.

Data of over 25,000 people with severe sepsis or septic shock was analyzed by an international team of experts in 186 locations throughout the United States and Europe.

The scientists discovered that there were 12% more people dying from sepsis-related causes in hospitals across Europe. However, the variation in death rates between the two continents was not significant when they controlled for variables, such as the type of organ failure and the origin of the illness.

This was the first report to directly compare the outcomes between the U.S. and Europe in people with these conditions. The experts wanted to evaluate whether hospitals were abiding by the international targets and recommendations for sepsis care, also known as the Survivng Sepsis Campaign.

Peripheral outcomes of the research included length of stay in hospital, length of stay in ICU (Intensive Care Unit), and hospital mortality. Considerable disparities between each of these measures were found.

Results showed:

  • 65% of patients were admitted to ICU from the emergency department in the U.S.
  • 52% of patients were taken to ICU from general wards in Europe
  • The average length of stay in ICU was 1 day in Europe
  • The average length of stay in ICU was just a few hours, or 0.1 days, in the U.S.

The variation in unadjusted average mortality rates between the continents does not imply that European Hospitals have a poorer quality of care, the team explained.

The results could just mean that their critical care is handled by different strategies. For example, European patients are more inclined to be taken to ICU when they are sicker, causing higher death rates.

Professor Mitchell Levy, at Rhode Island Hospital and The Warren Alpert Medical School of Brown University, USA, lead author, explained:

“These results raise important questions about the effect of the approach to critical care in Europe compared with that in the USA. Given the higher number of ICU beds per head in the USA than in Europe, more patients with less serious cases of sepsis might be admitted to the ICU. However, this is not at all clear from existing research, and further investigation is urgently needed if we are to be able to accurately monitor, and ultimately improve, sepsis care.”

Dr. Julian Bion at the Queen Elizabeth Hospital, Birmingham, UK, concluded:

“The investigators identified important international differences in processes and outcomes of care, which, taken together, provide a convincing argument for the need to address variation in structure and process to reduce mortality from this lethal and complex disease.”

Written by Sarah Glynn