People have the right to be involved in discussions and make informed decisions about their care, as described in NICE's information on making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
Healthcare professionals should follow our general guidelines for people delivering care:
For people aged 16 or over in the community and in custodial settings, grade risk of severe illness or death from sepsis using the person's:
history
physical examination results and
criteria based on age (for people aged 16 or over who are not and have not recently been pregnant; see table 1. [2016, amended 2024]
Recognise that people aged 16 or over with suspected sepsis in the community and in custodial settings are at:
high risk of severe illness or death from sepsis if they meet any of the high-risk criteria in table 1
moderate to high risk of severe illness or death from sepsis if they meet any of the moderate- to high-risk criteria in table 1. [2016, amended 2024]
If people aged 16 or over with suspected sepsis in the community and in custodial settings do not meet any high-risk or moderate- to high-risk criteria, see them as being at low risk of severe illness or death from sepsis. [2016, amended 2024]
| Category | High-risk criteria | Moderate- to high-risk criteria |
|---|---|---|
|
History |
Objective evidence of new altered mental state |
History from patient, friend or relative of new onset of altered behaviour or mental state History of acute deterioration of functional ability Impaired immune system (illness or drugs including oral steroids) Trauma, surgery or invasive procedures in the last 6 weeks |
|
Respiratory |
Raised respiratory rate: 25 breaths per minute or more New need for oxygen (40% FiO2 or more) to maintain saturation more than 92% (or more than 88% in chronic hypercapnic respiratory failure) See recommendation 1.4.10 for safety warnings about the use of pulse oximeters |
Raised respiratory rate: 21 to 24 breaths per minute |
|
Blood pressure |
Systolic blood pressure 90 mmHg or less or systolic blood pressure more than 40mmHg below normal |
Systolic blood pressure 91 to 100 mmHg |
|
Circulation and hydration |
Raised heart rate: more than 130 beats per minute Not passed urine in previous 18 hours For catheterised patients, passed less than 0.5 ml/kg of urine per hour |
Raised heart rate: 91 to 130 beats per minute (100 to 130 beats per minute in pregnancy) or new-onset arrhythmia Not passed urine in the past 12 to 18 hours For catheterised patients, passed 0.5 ml/kg to 1 ml/kg of urine per hour |
|
Temperature |
– |
Tympanic temperature less than 36°C |
|
Skin |
Mottled or ashen appearance Cyanosis of skin, lips or tongue Non-blanching petechial or purpuric rash For signs and symptoms of meningococcal disease, see the NICE guideline on bacterial meningitis and meningococcal disease |
Signs of potential infection, including redness, swelling or discharge at surgical site or breakdown of wound |
This table is also downloadable as a visual summary on evaluating risk of severe illness or death in community or custodial settings.
NICE has also produced a visual summary on evaluating risk of severe illness or death in acute healthcare settings with NEWS2.
In people aged 16 or over, grade risk of severe illness or death from sepsis using the person's:
history
physical examination results (especially symptoms and signs of infection – in line with the recommendations on when to suspect sepsis) and
NEWS2 score.
Interpret the NEWS2 scores within the context of the person's underlying physiology and comorbidities. [2024]
When evaluating the risk of severe illness or death from sepsis in people aged 16 or over with suspected or confirmed infection, use clinical judgement to interpret the NEWS2 score and recognise that:
a score of 7 or more suggests high risk of severe illness or death from sepsis
a score of 5 or 6 suggests a moderate risk of severe illness or death from sepsis
a score of 1 to 4 suggests a low risk of severe illness or death from sepsis
a score of 0 suggests a very low risk of severe illness or death from sepsis
if a single parameter contributes 3 points to their NEWS2 score, request a high-priority review by a clinician with core competencies in the care of acutely ill patients (FY2 or above), for a definite decision on the person's level of risk of severe illness or death from sepsis. [2024]
Consider evaluating the person's risk of severe illness or death from sepsis as being higher than suggested by their NEWS2 score alone if any of the following is present:
mottled or ashen appearance
non-blanching petechial or purpuric rash
cyanosis of skin, lips or tongue. [2024]
Consider evaluating the person's risk of severe illness or death from sepsis as being higher than suggested by their NEWS2 score alone if there is cause for concern because of deterioration or lack of improvement of the person's condition since:
any previous NEWS2 score was calculated
any interventions have taken place.
This should include taking into account any NEWS2 score calculated or intervention carried out before initial assessment in the emergency department. [2024]
For a short explanation of why the committee made the 2024 recommendations and how they might affect practice, see the rationale and impact section on evaluating risk level in people with suspected sepsis in acute hospital settings, acute mental health settings and ambulances.
Full details of the evidence and the committee's discussion are in evidence review A: stratifying risk of severe illness or death from sepsis.
Recalculate the NEWS2 score and re-evaluate risk of sepsis periodically, in line with the AoMRC statement on the initial antimicrobial treatment of sepsis (2022):
every 30 minutes, for those at high risk of severe illness or death from sepsis
every hour, for those at moderate risk of severe illness or death from sepsis
every 4 to 6 hours, for those at low risk of severe illness or death from sepsis
when standard observations are carried out, in line with local protocol, for those at very low risk of severe illness or death from sepsis. [2024]
If there is deterioration or an unexpected change in the person's condition, recalculate the NEWS2 score and re-evaluate their risk of sepsis. [2024]
For a short explanation of why the committee made the 2024 recommendations and how they might affect practice, see the rationale and impact section on evaluating risk level in people with suspected sepsis in acute hospital settings, acute mental health settings and ambulances.
Full details of the evidence and the committee's discussion are in evidence review A: stratifying risk of severe illness or death from sepsis.