Suspected sepsis: summary of NICE guidance

Abstract

The UK Parliamentary and Health Service Ombudsman inquiry “Time to Act” found failures in the recognition, diagnosis, and early management of those who died from sepsis, which triggered this guidance. In sepsis the body’s immune and coagulation systems are switched on by an infection and cause one or more body organs to malfunction with variable severity. The condition is life threatening. Although most people with infection do not have and will not develop sepsis, non-specific signs and symptoms can lead to late recognition of people who might have sepsis. We would like clinicians to “think sepsis” and recognise symptoms and signs of potential organ failure when they assess someone with infection, in a similar way to thinking “Could this chest pain be cardiac in origin?”

This guidance provides a pragmatic approach for patients with infection who are assessed in the community, emergency departments, and hospitals by a wide range of general and specialist healthcare professionals. It includes guidance on assessment of risk factors followed by a detailed structured assessment of potential clinical signs and symptoms of concern.

Definitions of sepsis have been developed, but these offer limited explanation on how to confirm or rule out the diagnosis in general clinical settings or in the community. Current mechanisms to diagnose sepsis and guidelines for use largely apply to critical care settings such as intensive care. We recognised a need for better recognition of sepsis in non-intensive settings and for the diagnosis to be entertained sooner.

While sepsis is multifactorial and rarely presents in the same way, the Guideline Development Group considered that use of an easy, structured risk assessment may help clinicians identify those most severely ill who require immediate potentially lifesaving treatment. This guideline ensures that patients defined as having sepsis by recent definitions are, as a minimum, assessed as moderate-high risk. This guidance is also about appropriate de-escalation if sepsis is unlikely and broad spectrum antibiotics or hospital admission are not appropriate.

This article summarises recommendations from the National Institute for Health and Care Excellence (NICE) guideline for the recognition, diagnosis, and management of sepsis in children and adults. Recommendations and the clinical pathway are available via the NICE website, and the UK Sepsis Trust tools are being revised to align with this guidance. This article is accompanied by an infographic, which displays the NICE guideline as a decision making tool.

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Identifiers

ORCID for S. Faust: orcid.org/0000-0003-3410-7642

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