The National Institute for Health and Care Excellence (NICE) has published a clinical guideline on the recognition, diagnosis, and early management of sepsis. The guidance covers children and adults, and is for health professionals working in all settings.1
The Health Service Ombudsman identified sepsis as one of the main causes of avoidable death2 and the Sepsis Action Plan (2015) suggested that better treatment could reduce mortality and morbidity associated with sepsis, and that 10 000 deaths a year could be prevented.3
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.4 The challenge for all healthcare professionals is to identify sepsis before significant organ failure has occurred. The challenge for primary care clinicians is to detect the small number of patients who might have sepsis among the many patients who present with an uncomplicated infection and who do not have and will not develop sepsis. The guideline recognises that clinical judgement is always required and aims to ensure patients are assessed appropriately to pick up any clues to the presence of sepsis.
The overwhelming nature of sepsis means that usual markers of infection such as a temperature may not develop. In fact the temperature may be low because the patient may not be able to mount a febrile response. Patients may instead have nonspecific, non-localised presentations such as feeling very unwell. However, sepsis may lead to organ failure, such as acute kidney injury, cardiovascular impairment including tachycardia, septic shock or cardiac arrest, respiratory failure, or impact on the central nervous system
The NICE guideline starts with a recommendation to think ‘Could this be sepsis?’ when a patient with infection contacts a healthcare professional. The guideline uses the analogy of chest pain, where the …