Suspected sepsis: summary of NICE guidance

The study by Lim et al is based on the consultation version of the guideline, so it is not a valid critique of the final version. The issues raised by Lim are similar to issues raised by stakeholders during consultation, which the guideline committee and NICE took into account when drafting the final version.

The potential overuse of tests and broad spectrum antibiotics in children or adults with defined conditions other than sepsis is dealt with in the final version of the guidance by a requirement for immediate senior clinician review (ST4 or above in paediatrics). Those with a diagnosis other than sepsis can immediately de-escalate to a different pathway, and broad spectrum antibiotics do not have to be given. This is true for both high risk and moderate-to-high risk cases.

The individual parameters for heart and respiratory rates are in fact higher than equivalent APLS guidelines or criteria, using the 99th centile (for high risk) from Fleming et al (1), the only large published dataset available.

Saul N. Faust, Norma O'Flynn, Caroline Keir and Martin Allaby

(1) Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet (London, England). 2011; 377(9770):1011-1018