Surviving severe sepsis could lead to future cognitive problems

The 13th of September 2018 marks World Sepsis Day. It was originally initiated by the Global Sepsis Alliance in 2012 with the aim of raising awareness for sepsis worldwide. Since then, a lot of progress has been made but there is still relatively little known about the condition and the symptoms to look out for.

Sepsis is a medical emergency, just like a stroke, heart attack or multiple trauma and occurs when the body’s response to an infection injures its own tissues and organs. Sepsis follows a unique and time critical course but in the early stages it is highly amenable to treatment through early diagnosis and timely and appropriate clinical management.

Brain injury and sepsis

A delay in the diagnosis of sepsis can, in some circumstances, cause irreversible brain damage and we have been involved in a number of medical negligence cases recently where this has occurred. Usually this type of injury is as a result of severe sepsis where treatment in intensive care is required. The medical term for this injury is ‘sepsis-associated encephalopathy’. This condition causes a number of symptoms including; confusion, hallucinations, a change in personality, poor sleep patterns (including nightmares), high levels of anxiety, poor levels of concentration, irrational behaviour (especially in busy environments) and irritability.

In some of the cases we have been involved in, our clients have reported an inability to cope in busy places, or in confined spaces like trains. Others describe difficulty in keeping up with conversations, especially in groups and simply begin avoiding social situations entirely. Whilst these may sound like minor issues, they are usually part of a deeper set of problems that culminate in having a major impact on both the life of the individual concerned and their family.

The impact of a failure to identify a brain injury caused by sepsis

If undiagnosed, members of the patient’s family may mistake the symptoms of sepsis induced encephalopathy, as simply a reaction by their loved one of a traumatic time in hospital, or perhaps depression due to the severe illness they have been through. In fact these patients can suffer depression, but often this is caused by the problems that develop, at home and at work, as a result of having an undiagnosed brain injury. They may struggle to maintain the jobs they used to manage with ease or become grumpy or awkward leading to a breakdown in relationships. The stresses of everyday life simply become too much to cope with and, without specialist support from clinicians and therapists familiar with the nuances of a brain injury, these individuals can find life very difficult to cope with.

Without the correct diagnosis of brain injury, general practitioners may only offer treatment to deal with a suspected depressive episode. However, many of the issues highlighted above will not be amenable to the usual treatment for depression (psychotherapies and anti-depressants) and this can leave patients and their families not knowing where to turn. With the correct diagnosis, however, there is a lot of support available for people who have suffered a brain injury and patients can be taught a wide range of coping techniques to make it easier to adapt and to better manage their condition. If the family is aware of the cause of their loved one’s behaviour and possible change in personality, then this should lead to a greater level of understanding and assistance, which in turn can make a huge difference to the injured person and their ability to cope with the life changing injury they have sustained.

Claiming compensation for a brain injury caused by sepsis

We are dealing with an increasing number of cases involving sepsis, and recently acted for a claimant who suffered sepsis induced encephalopathy, as a result of a long delay in the diagnosis of an infected appendix. He was treated in intensive care for two weeks and was in a coma for a prolonged period.

Having emerged from his coma, the patient developed symptoms of post traumatic stress disorder (PTSD), hallucinations, delirium, anxiety and suffered from an altered speech pattern. Despite all of these symptoms he was discharged home without any support and without a diagnosis for the cause of the ongoing problems he was experiencing.

A year later, after the family had struggled on alone, the patient visited our specialist clinical negligence team. Through our extensive work with other clients suffering from similar injuries, we suspected that the patient had suffered a brain injury, even though this hadn’t been identified by the patient’s GP or during subsequent visits to the hospital. Following our initial meeting with the client, it was recommended the patient consult a neurologist and a neuropsychologist, to investigate his condition. A brain injury was eventually diagnosed and treatment commenced, however the patient will require care and assistance for the remainder of his life and he is left unable to work at all. The case eventually settled for £2million.

Sepsis and sepsis-associated encephalopathy cases are highly complex and achieving a settlement can require the assistance of a large number of independent experts covering the fields of; anaesthetics, neurology, neuroradiology, neuropsychiatry, neuropsychology, care and occupational therapy, physiotherapy and accommodation. It is therefore crucial that any initial discussion relating to a possible claim, is with a firm that specialises in medical negligence and has expert knowledge of sepsis related cases.