Sepsis is a time-critical medical emergency, which can occur as part of the body’s response to infection. Unless treated quickly, sepsis can progress to severe sepsis, multi-organ failure, septic shock and ultimately death. For more information and resources, please see the UK Sepsis Trust Webpages.
Sepsis affects all age groups but has a higher incidence in the elderly (95 patients per 100,000 population <65 years versus 1,220 per 100,000 >65years).1 Over 70% of cases arise in the community so general practice has an important role to play in diagnosis and rapid referral.
National Early Warning Scores (NEWS)
NEWS is a validated national score made up of six routinely recorded physiological parameters:
- respiratory rate,
- oxygen saturations,
- systolic blood pressure,
- pulse rate and
- level of consciousness
NEWS is shown to be a good predictor of mortality in the next 24 hours and improves patient survival when used by clinicians. NEWS is available on EmisWeb as a downloaded add-on.
NHS West Hampshire CCG are working with a local primary care practice to evaluate the application of NEWS to general practice and to define escalation protocols based on NEWS. We will publish more information on the progress of this project soon.
- Hall MJ, Williams SN, DeFrances CJ, Golosinskiy A. Inpatient care for septicemia or sepsis: A challenge for patients and hospitals.National Center for Health Statistics. 2011
- Daniels R, Nutbeam T, McNamara G et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Em Med J 2011; 28: 507-512
- Kumar A, Roberts D, Wood KE et al. Duration of hypotension prior to initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006; 34: 1589–96
- Gaieski DF, Mikkelsen ME, Band RA et al. Impact of time to antibiotics on survival in patients with severe sepsis or septic shock in whom early goal-directed therapy was initiated in the emergency department. Crit Care Med 2010; 38: 1045–53
- Yeh RW, Sidney S, Chandra M, et al.: Population trends in the incidence and outcomes of acute myocardial infarction. NEJM 2010; 362: 2155-2165
- Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: a systematic review. Lancet Neurology 2009; 8: 355-369
- Intensive Care National Audit and Research Centre Case Mix Programme database, interrogated July 2007
- Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, et al. (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29: 1303–1310.
- Vincent JL, Sakr Y, Sprung CL, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med 2006; 34: 344-353
- Iwashyna TJ1, Ely EW, Smith DM,et al.Long-term cognitive impairment and functional disability among survivors of severe sepsis. JAMA. 2010 Oct 27;304(16):1787-94. doi: 10.1001/jama.2010.1553.