But there are some times when the signs are obvious. Mehrotra, assistant medical director of UNC's emergency department, related a recent experience in which a 12-year-old came in with a fever, high heart rate and abnormal white blood cell count. Mehrotra and his team immediately suspected sepsis, he says, because the patient had cancer and was on chemotherapy. In this case, the body's immune system was compromised, and an infection was one of the top concerns on Mehrotra's list.
In a child who has a normal immune system and is in otherwise good health, however, "there may not be findings to take you down the sepsis road," he explains.
Experts agree that there aren't any easy answers to the question of how to identify rare but deadly conditions in patients who are unlikely to have them. Mehrotra acknowledges that with so many patients coming to the emergency department with the same common symptoms, the problem defies blanket solutions.
"If we just hospitalized all of these patients," says Mehrotra, "we wouldn't be able to treat anyone else."