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Management of Sepsis in Older Patients in the Emergency Department

  • Abdelouahab Bellou
  • Hubert Blain
  • Vishal Sehgal
Chapter

Abstract

Sepsis is a serious problem among the older population as its incidence and mortality rates dramatically increase with advanced age. Although sepsis is a serious life-threatening disease, there is an under recognition as compared to other age-related diseases.

Older patients with severe comorbidities or with age greater than 80 years are often excluded in clinical research on sepsis. However, this population is frequently managed in the emergency department (ED), and their management is a daily challenge for emergency physicians and geriatricians. The diagnosis is often difficult because of atypical clinical presentation, which might delay the administration of appropriate treatment. To date, the management of sepsis and septic shock in older patients followed the most updated international guidelines from the Surviving Sepsis Campaign. The strategy of early identification and institution of appropriate management was proven to improve the outcomes in patients with sepsis including older patients, but stronger evidences are still needed in this specific population. Time is critical, and the treatment must be started as soon as a diagnosis of infection and sepsis is suspected.

Besides numerous prognostic scores that measure the risk of death in critically ill patients, frailty should be assessed with frailty score adapted to critically ill older sepsis patients (e.g., Clinical Frailty Score).

Keywords

Older patients Sepsis Septic shock Emergency medicine department Surviving Sepsis Campaign guidelines 

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Copyright information

© Springer International Publishing Switzerland 2018

Authors and Affiliations

  • Abdelouahab Bellou
    • 1
  • Hubert Blain
    • 2
  • Vishal Sehgal
    • 3
  1. 1.Department of Emergency MedicineBeth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  2. 2.Department of GeriatricsUniversity Hospital of Montpellier, University of MontpellierMontpellierFrance
  3. 3.Department of EndocrinologyIndiana University, St. Vincent HospitalCarmelUSA

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