What is… Sepsis?

Sepsis is often described as the body’s “overreaction” to infection, but that phrase barely captures its seriousness. This life-threatening condition, sometimes called septicaemia or blood poisoning, is a leading cause of critical illness and death worldwide.

For clinicians, early recognition and swift intervention can mean the difference between life and death. For solicitors and expert witnesses, sepsis cases frequently appear in clinical negligence claims, where delayed diagnosis or treatment is alleged. Understanding sepsis both medically and legally is therefore essential.

What is Sepsis?

Sepsis occurs when the body’s immune system responds to infection in a way that spirals out of control. Instead of targeting the infection alone, the immune response becomes widespread, triggering inflammation, tissue damage, and ultimately organ dysfunction.

Common sources of sepsis include:

• Pneumonia (chest infections).

• Urinary tract infections (particularly in older adults).

• Abdominal infections (such as perforated bowel or appendicitis).

• Skin or soft tissue infections (including cellulitis, wounds, or abscesses).

If untreated, sepsis can progress to septic shock, where blood pressure falls dangerously low, organs fail, and death may follow.

Who is Most at Risk?

Sepsis can affect anyone, but certain groups are more vulnerable:

• Infants and young children.

• Elderly individuals.

• People with weakened immune systems (e.g., from chemotherapy, diabetes, or long-term steroid use).

• Patients with chronic conditions such as kidney disease or lung disease.

• Post-operative patients or those with indwelling devices (catheters, lines).

Recognising risk factors is critical in both clinical care and medico-legal assessments.

Signs and Symptoms

Sepsis is notorious for presenting with non-specific symptoms. This is one reason it is so often missed.

Common warning signs include:

• Fever, chills, or shivering.

• Rapid breathing or difficulty breathing.

• Confusion, drowsiness, or altered mental state.

• Fast heart rate.

• Low blood pressure.

• Reduced urine output.

• Skin mottling, clamminess, or bluish discolouration.

In children, symptoms may include lethargy, not feeding, vomiting, or seizures.

The UK Sepsis Trust uses a simple message: “Just ask - could it be sepsis?” Early suspicion saves lives.

Diagnosing Sepsis

Diagnosis relies on:

• Clinical assessment: vital signs, history, examination.

• Laboratory tests: blood cultures, lactate levels, kidney and liver function.

• Scoring systems: NEWS2 (National Early Warning Score) for adults, PEWS (Paediatric Early Warning Score) for children.

Delays in diagnosis are a recurring theme in negligence claims. Where early warning scores were not acted upon or sepsis protocols not followed, legal liability may arise.

Treating Sepsis

Time is critical. The “Sepsis Six” bundle is a recognised UK standard for initial management:

1. Administer oxygen.

2. Take blood cultures.

3. Give intravenous antibiotics.

4. Start intravenous fluids.

5. Check lactate and haemoglobin.

6. Monitor urine output.

These should be delivered within one hour of recognition. In severe cases, patients may require admission to intensive care, vasopressors to support blood pressure, and organ support such as ventilation or dialysis.

Sepsis and Clinical Negligence

Sepsis is a common feature in clinical negligence litigation. Claims often involve:

• Failure to recognise sepsis early through missed or misinterpreted symptoms, especially in A&E or GP settings.

• Delayed treatment like failure to give antibiotics within the crucial first hour.

• Failure to escalate, where junior staff do not alert seniors, or ignore abnormal vital signs.

• Inadequate follow-up, patients can be discharged too early, only to deteriorate at home.

Legal Tests

• Breach of duty: Was the standard of care reasonable in recognising and treating sepsis?

• Causation: Would earlier recognition or treatment have avoided deterioration, organ failure, or death?

Condition & prognosis reports are also vital in sepsis claims, as survivors often live with long-term consequences such as chronic pain, fatigue, organ damage, or amputations.

The Role of Expert Witnesses

In sepsis litigation, expert witnesses may include:

• Emergency medicine specialists (A&E presentation and triage).

• General practitioners (missed diagnosis in primary care).

• Intensivists (ICU management).

• Microbiologists or infectious disease experts (antibiotic timing and choice).

• Nurses (monitoring and escalation of deteriorating patients).

Experts assess whether care met accepted standards and whether delays materially affected outcomes. For courts, this evidence is often decisive.

Prevention and Public Awareness

Public health campaigns stress the importance of awareness, both for clinicians and the public. The mantra “Could it be sepsis?” has helped increase vigilance, but litigation shows that missed opportunities still occur.

Prevention also includes:

• Vaccinations.

• Infection control in hospitals.

• Early treatment of infections.

Final Thoughts

Sepsis is a devastating condition, but also one where early recognition and intervention can save lives. For patients and families, awareness is empowering. For clinicians, vigilance is essential.

In the medico-legal world, sepsis cases highlight the consequences of delay, miscommunication, and missed opportunities. Condition & prognosis reports, breach of duty assessments, and causation opinions all converge on one question: could timely action have changed the outcome?

At Apex Experts, our panel includes specialists across emergency medicine, nursing, intensive care, and microbiology. We provide impartial, court-ready evidence to help clarify the medical and legal issues in sepsis cases.