Suspected sepsis in people aged 16 or over: recognition, assessment and early management

Why this is important

The lack of robust UK based epidemiological studies on the incidence and outcomes from sepsis have been clear throughout the guideline development process. A large epidemiological study to collect information about where sepsis is being treated, patient interventions and patient outcomes would provide population-based statistics on epidemiology of sepsis which are necessary to support evaluation of interventions, planning of services and service redesign. The mortality and morbidity and service complexity associated with severe infection and sepsis, and the need to use broad-spectrum antimicrobials to treat sepsis, justifies the cost required to set up such a study.

Why this is important

The NEWS2 has been introduced in 2017 and is widely used across the NHS pre-hospital and acute care settings. However, evidence on the NEWS2 was not found. It is important to investigate, over a 5- to 10‑year period, the success, safety and possible implications on people with suspected sepsis and clinical staff of using the NEWS2 to stratify the risk of severe illness or death from sepsis.

Lack of data to stratify risk of severe illness or death from sepsis and estimate possible risk of deterioration in people with a single parameter contributing 3 points to their NEWS2 score is also of great concern. Data relating to this is scarce and its interpretation contradictory.

Why this is important

In primary care and emergency departments people with suspected sepsis are often seen by relatively inexperienced doctors. Many of these people will be in low and medium risk groups but evidence is lacking as to who can be sent home safely and who needs intravenous or oral antibiotics. The consequences of getting the decision making wrong can be catastrophic and therefore many patients are potentially over-investigated and admitted inappropriately. Current guidance is dependent on use of individual variables informed by low quality evidence.

Why this is important

Diagnosing and treating an underlying infection could prevent serious illness or death in a person who has or is at risk of developing sepsis. However, starting treatment too early could lead to people without an infection being given antibiotics, or people being given inappropriate antibiotics for their infection.

Early use of rapid microbiological tests could help diagnose infection faster, leading to quicker, more targeted treatment and better patient outcomes. These tests are currently used in the NHS, but more research is needed to measure their utility in people with suspected sepsis.

Why this is important

Vasopressors are part of the treatment for hypotension and hypotensive shock in people with sepsis. Research is needed into the safety of administering these peripherally. This includes details on the safety of different durations, doses and concentrations, which would give clinicians more information to make decisions on whether to start vasopressors peripherally when these are needed.