Question special

Me again! Thanks so much for your earlier responses! I was wondering about your take on the new Sepsis-3 definition. Promise, Process, Arise, and Rivers all used the previous definitions of sepsis and septic shock. Will the ongoing trials use this definition or the new Sepsis-3 definition to screen patients? In the three trials, 30-46% of patients met entry criteria by lactate level alone. The mortality of these patients was 30%. Since neither qSOFA or SOFA score use lactate, what effect will this have on early detection and treatment of sepsis in the ED? Do you worry about some patients being missed if they clinically look well (qSOFA of 0) and a lactate is never checked?