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Practice Guidelines

Recognition, diagnosis, and early management of suspected sepsis: summary of updated NICE guidance

BMJ 2024; 385 doi: (Published 18 June 2024) Cite this as: BMJ 2024;385:q1173
  1. Anthony Gildea, technical analyst1,
  2. Caroline Mulvihill, technical adviser1,
  3. Emma McFarlane, technical adviser1,
  4. Alasdair Gray, consultant in emergency medicine2,
  5. Mervyn Singer, professor of intensive care medicine3
  6. on behalf of the guideline committee
    1. 1National Institute for Health and Care Excellence, UK
    2. 2NHS Lothian, UK
    3. 3University College London, UK
    1. Correspondence to A Gildea Anthony.gildea{at}

    What you need to know

    • Calculate NEWS2 scores to determine an adult’s risk of severe illness or death from sepsis in acute hospital, mental health, and ambulance settings

    • Use the person’s risk level to help determine the time window in which to give antibiotics

    Sepsis is defined as life threatening organ dysfunction caused by a dysregulated host response to infection.1 In 2016, the National Institute for Health and Care Excellence (NICE) first published guidance on recognising, diagnosing, and managing suspected sepsis. In May 2022, a statement published by the Academy of Medical Royal Colleges2 (and endorsed by NHS England) on use of the updated National Early Warning Score (NEWS2)3 sought to guide the urgency of antibiotic prescribing and source control. The statement was based on a narrative review of the literature and expert clinical consensus.

    As a result, in January 2024, NICE guidance was updated to include NEWS2 for stratifying risk of severe illness or death from sepsis.4 The updated guideline aims to ensure that early recognition of patient deterioration and treatment for sepsis becomes standardised nationally, and includes recommendations on the timing of antibiotic prescribing based on a person’s risk level, while investigating the underlying infection source.


    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline committee’s expertise and opinion of what constitutes good practice. A subsequent consultation process with stakeholder bodies provides external confirmation. Evidence levels for the recommendations are given in italic in square brackets.

    GRADE Working Group grades of evidence

    • High certainty—we are very confident that the true effect lies close to that of the estimate of the effect.

    • Moderate certainty—we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there …

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