Emergency Medicine Physician Fails to Diagnose Sepsis

This case involves a ten-year-old male patient who was taken to the hospital by EHS with vomiting, fever, and left lower leg pain after injuring himself in a basketball game. The patient was worked up by the emergency room (ER) physician and diagnosed with dehydration. The patient was discharged with instructions to follow up with his primary care physician in the event any new symptoms arise. A few days later, the patient was readmitted to the hospital after experiencing a bout of intractable vomiting. His working diagnosis and admission was now supported on the basis of septic shock. He was transferred to the intensive care unit but was unable to be properly resuscitated. The patient fell into severe sepsis with multiple organ dysfunction and expired five days after he presented to the emergency room.

Question(s) For Expert Witness

1. Should this patient have been more extensively evaluated upon his first emergency room visit and what is the standard of care in diagnosing sepsis?

Expert Witness Response E-000781

SIRS is the body’s natural response to any insult of infectious or noninfectious origin. Sepsis can be diagnosed once the criteria for SIRS is met, and the responsible insult is identified. In order to completely evaluate for SIRS, a number of tests must be done. These include blood cultures, urinalysis and culture, cardiac enzymes, amylase, lipase spinal fluid, and liver profiles. Routine screenings can also be run, as well as other, more specific lab tests based on the patient's history and physical exam findings. In the event of pediatric cases of sepsis, it is important to note that sepsis may present with other complications of infection without meeting the exact SIRS criteria.