Evaluating risk level

NICE has produced visual summaries on evaluating risk of severe illness of death from sepsis in:

1.5 Grading risk

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1.5.1

In people under 16, grade risk of severe illness or death from sepsis using the person's:

history
physical examination results and
criteria based on age (see table 1: criteria for stratification of risk from sepsis in under 5s, table 2: criteria for stratification of risk from sepsis in children aged 5 to 11 and table 3: criteria for stratification of risk from sepsis in young people aged 12 to 15). [2016]

1.5.2

Recognise that people under 16 with suspected sepsis are at high risk of severe illness or death from sepsis if they meet any of the high risk criteria:

For children under 5, see high risk criteria in table 1.
For children aged 5 to 11, see high risk criteria in table 2.
For young people aged 12 to 15, see high risk criteria in table 3. [2016]

1.5.3

Recognise that people under 16 with suspected sepsis are at moderate to high risk of severe illness or death from sepsis if they meet any of the moderate to high risk criteria:

For children under 5, see moderate to high risk criteria in table 1.
For children aged 5 to 11, see moderate to high risk criteria in table 2.
For young people aged 12 to 15, see moderate to high risk criteria in table 3. [2016]

1.5.4

If people under 16 with suspected sepsis do not meet any high or moderate to high risk criteria, see them as being at low risk of severe illness or death from sepsis. [2016]

Criteria for stratification of risk from sepsis in under 5s

**Table 1: Criteria for stratification of risk of severe illness or death from sepsis in children under 5**
Category	Age	High risk criteria	Moderate to high risk criteria
Behaviour	Any	No response to social cues Appears ill to a healthcare professional Does not wake, or if roused does not stay awake Weak high-pitched or continuous cry	Not responding normally to social cues No smile Wakes only with prolonged stimulation Decreased activity Parent or carer concern that child is behaving differently from usual
Respiratory	Any	Grunting Apnoea Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline See recommendation 1.4.9 for safety warnings about the use of pulse oximeters	Oxygen saturation of less than 92% in air or increased oxygen requirement over baseline Nasal flaring See recommendation 1.4.9 for safety warnings about the use of pulse oximeters
Respiratory	Under 1 year	Raised respiratory rate: 60 breaths per minute or more	Raised respiratory rate: 50 to 59 breaths per minute
Respiratory	1 to 2 years	Raised respiratory rate: 50 breaths per minute or more	Raised respiratory rate: 40 to 49 breaths per minute
Respiratory	3 to 4 years	Raised respiratory rate: 40 breaths per minute or more	Raised respiratory rate: 35 to 39 breaths per minute
Circulation and hydration	Any	Bradycardia: heart rate less than 60 beats per minute	Capillary refill time of 3 seconds or more Reduced urine output For catheterised patients, passed less than 1 ml/kg of urine per hour
Circulation and hydration	Under 1 year	Rapid heart rate: 160 beats per minute or more	Rapid heart rate: 150 to 159 beats per minute
Circulation and hydration	1 to 2 years	Rapid heart rate: 150 beats per minute or more	Rapid heart rate: 140 to 149 beats per minute
Circulation and hydration	3 to 4 years	Rapid heart rate: 140 beats per minute or more	Rapid heart rate: 130 to 139 beats per minute
Skin	Any	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.	Pallor of skin, lips or tongue
Temperature	Any	Less than 36ºC	-
Temperature	Under 3 months	38°C or more	-
Temperature	3 to 6 months	-	39°C or more
Other	Any	-	Leg pain Cold hands or feet

This table is also downloadable as a visual summary on evaluating risk of severe illness or death from sepsis in children under 5.

Criteria for stratification of risk from sepsis in children aged 5 to 11

**Table 2: Criteria for stratification of risk of severe illness or death from sepsis in children aged 5 to 11 years**
Category	Age	High risk criteria	Moderate to high risk criteria
Behaviour	Any	Objective evidence of altered behaviour or mental state Appears ill to a healthcare professional Does not wake or if roused does not stay awake	Not behaving normally Decreased activity Parent or carer concern that the child is behaving differently from usual
Respiratory	Any	Oxygen saturation of less than 90% in air or increased oxygen requirement over baseline See recommendation 1.4.9 for safety warnings about the use of pulse oximeters	Oxygen saturation of less than 92% in air or increased oxygen requirement over baseline See recommendation 1.4.9 for safety warnings about the use of pulse oximeters
Respiratory	Aged 5 years	Raised respiratory rate: 29 breaths per minute or more	Raised respiratory rate: 24 to 28 breaths per minute
Respiratory	Aged 6 to 7 years	Raised respiratory rate: 27 breaths per minute or more	Raised respiratory rate: 24 to 26 breaths per minute
Respiratory	Aged 8 to 11 years	Raised respiratory rate: 25 breaths per minute or more	Raised respiratory rate: 22 to 24 breaths per minute
Circulation and hydration	Any	Heart rate less than 60 beats per minute	Capillary refill time of 3 seconds or more Reduced urine output For catheterised patients, passed less than 1 ml/kg of urine per hour
Circulation and hydration	Aged 5 years	Raised heart rate: 130 beats per minute or more	Raised heart rate: 120 to 129 beats per minute
Circulation and hydration	Aged 6 to 7 years	Raised heart rate: 120 beats per minute or more	Raised heart rate: 110 to 119 beats per minute
Circulation and hydration	Aged 8 to 11 years	Raised heart rate: 115 beats per minute or more	Raised heart rate: 105 to 114 beats per minute
Temperature	Any	-	Tympanic temperature less than 36°C
Skin	Any	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.	-
Other	Any	-	Leg pain Cold hands or feet

This table is also downloadable as a visual summary on evaluating risk of severe illness or death from sepsis in children aged 5 to 11.

Criteria for stratification of risk from sepsis in young people aged 12 to 15

**Table 3: Criteria for stratification of risk of severe illness or death from sepsis in young people aged 12 to 15 in any setting**
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 known chronic hypercapnic respiratory failure) See recommendation 1.4.9 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 40 mmHg 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 from sepsis in young people aged 12 to 15.