1.5.1
In people who are or have recently been pregnant, grade risk of severe illness or death from sepsis using:
-
the person's history
-
physical examination results and
Evaluating risk level
For people who are or have recently been pregnant, NICE has produced a visual summary on evaluating risk of severe illness or death from sepsis.
1.5 Grading risk
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.
1.5.2
Recognise that people with suspected sepsis who are or have recently been pregnant are at:
-
high risk of severe illness or death from sepsis if they meet any of the high risk criteria in table 1: criteria for stratification of risk from sepsis in people who are or have recently been pregnant
-
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: criteria for stratification of risk from sepsis in people who are or have recently been pregnant. [2016]
1.5.3
If people with suspected sepsis who are or have recently been pregnant 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]
Criteria for stratification of risk from sepsis in people who are or have recently been pregnant
| 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 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: 100 to 130 beats per minute 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 available to download as a visual summary on evaluating risk of severe illness or death in all settings.