qSOFA ( quick Sequential ( Sepsis-related ) Organ failure Assessment ): respiratory rate of 22 / min or greater , altered mentation , or systolic blood pressure of 100 mmHg or less , for rapid bedside assessment with higher predictive validity of sepsis than traditional SIRS criteria . Early sepsis-related organ dysfunction was defined as an acute change in total SOFA score ≥ 2 points , because of infection .
The National Early Warning score ( NEWS ) was first produced in 2012 and updated ( NEWS2 ) in December 2017 . 5 NHS England and NHS Improvement have endorsed NEWS2 , which is based on a simple aggregate scoring system in which a score is allocated to physiological parameters routinely measured in clinical practice – respiratory rate , oxygen saturation , systolic blood pressure , pulse rate , level of consciousness or new confusion and temperature . 6 Three of these parameters are same as those of qSOFA and with added parameters from NEWS2 , the ability to identify patients at risk of sepsis will be remarkably enhanced . A raised NEWS of 5 or more should trigger immediate escalation of treatment and patients affected treated for sepsis until proven otherwise , as this failure to do so has been shown to be associated with a > threefold increased risk of transfer to the intensive care unit or death . 7
Burden of surgical sepsis NHS England have estimated that approximately 120,000 patients develop sepsis each year and more than 37,000 people die as a consequence . Sepsis is the second most common cause of death after cardiovascular disease . 6 While these data relate to sepsis resulting from all infection , the most common cause of sepsis in surgical patients is intra-abdominal infection , which accounts for approximately two-thirds of all cases . 8 , 9 While sepsis might arise from intra-abdominal ( or retroperitoneal ) infection resulting from upper gastrointestinal , hepato-pancreaticobiliary and small intestinal disease , colonic ( including appendicular ) perforation predominates . 10
It is sobering to note that Moynihan ’ s 1920 observations still remain valid , and a significant proportion of hospital-acquired sepsis arises as a direct consequence of complications of abdominal surgery . The National Confidential Enquiry into Patient Outcome and Death ( NCEPOD ) review Just Say Sepsis 11 noted that more than 60 % of patients with hospital-acquired sepsis developed their infection as a result of an invasive procedure . 12
Despite advances in management , the development of septic shock in a patient with infection still has considerable negative prognostic implications . Septic shock is associated with an overall hospital mortality of 39 % in patients admitted as a surgical emergency and 30 % mortality in those admitted for elective surgery . 9 It is therefore imperative to identify sepsis promptly , commence resuscitation and antimicrobial therapy , and achieve rapid source control .
Initial resuscitation Current clinical guidelines on the management of sepsis , such as those from NHS England , 2 Surviving Sepsis Campaign , 13 the English National
qSOFA – respiratory rate of 22 / min or greater , altered mentation , or systolic blood pressure of 100mmHg or less , has higher predictive validity of sepsis for rapid bedside assessment
Institute for Health and Care Excellence 14 and the Irish National Clinical Effectiveness Committee , 15 all emphasise that sepsis is a medical emergency with a limited window of opportunity for effective intervention . The new sepsis Hour-1 Bundle spells out essential steps that should be undertaken in the first hour of managing a patient with suspected sepsis – this includes measuring blood lactate level , perform blood cultures , administration of intravenous antibiotics , fluids and oxygen and measuring hourly urine output . 16 The Surviving Sepsis Campaign has also introduced Time zero or Time of Presentation ( 2018 ), which is defined as the time of triage in the emergency department or , if presenting from another care venue , from the earliest chart annotation consistent with all elements of sepsis to improve compliance and performance . 16 The effect of morbidity and mortality in sepsis has been well documented and adopting sepsis care bundles has been shown to significantly reduce mortality . 17
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