Sepsis Recognition and Management in General Practice: The NEWS2 Approach
Early identification, the Sepsis Six, and safe transfer — a GP guide to the life-threatening emergency
Sepsis kills approximately 11 million people globally each year. Early recognition and the Sepsis Six bundle within the first hour significantly reduce mortality. This guide covers NEWS2 scoring, sepsis red flags, the Sepsis Six, and safe transfer from primary care.
Clinical Decision Support: This article is for educational purposes and supports — not replaces — clinical judgment. Always verify with current national guidelines, BNF, and specialist consultation when needed.
Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection. It kills approximately 11 million people globally each year and is responsible for approximately 48,000 deaths annually in the UK. Early recognition and prompt initiation of the Sepsis Six bundle within the first hour of recognition reduces mortality by up to 50%. GPs are often the first point of contact for patients developing sepsis, making early recognition a critical competency.
Sepsis Red Flags: Think Sepsis
Think Sepsis in any patient with a suspected or confirmed infection who appears acutely unwell. Do not wait for all criteria to be met — if in doubt, treat as sepsis.
- Altered mental status (new confusion, agitation, reduced consciousness)
- Respiratory rate ≥25 breaths/min
- Heart rate ≥130 bpm
- Systolic BP ≤90 mmHg or drop of >40 mmHg from baseline
- Temperature <36°C or >38.3°C
- Non-blanching rash (meningococcal)
- Mottled/ashen/cyanotic skin
- Not passed urine in last 18 hours (oliguria)
NEWS2 Score: Objective Risk Stratification
| Parameter | 3 | 2 | 1 | 0 | 1 | 2 | 3 |
|---|---|---|---|---|---|---|---|
| Resp rate | ≤8 | 9–11 | 12–20 | 21–24 | ≥25 | ||
| SpO2 (Scale 1) | ≤91 | 92–93 | 94–95 | ≥96 | |||
| Systolic BP | ≤90 | 91–100 | 101–110 | 111–219 | ≥220 | ||
| Heart rate | ≤40 | 41–50 | 51–90 | 91–110 | 111–130 | ≥131 | |
| Consciousness | Alert | CVPU | |||||
| Temperature | ≤35.0 | 35.1–36.0 | 36.1–38.0 | 38.1–39.0 | ≥39.1 |
- NEWS2 ≥5: High clinical risk — urgent clinical review; consider sepsis
- NEWS2 ≥7: Emergency response — call 999; initiate Sepsis Six
- Any single parameter scoring 3: Urgent review required
The Sepsis Six: Initiate Within 1 Hour
- 1. Give high-flow oxygen (15 L/min via non-rebreather mask; target SpO2 ≥94%)
- 2. Take blood cultures (before antibiotics if possible — do not delay antibiotics)
- 3. Give IV antibiotics (broad-spectrum: co-amoxiclav + gentamicin, or piperacillin-tazobactam)
- 4. Give IV fluid challenge (500 mL crystalloid over 15 minutes if hypotensive)
- 5. Check lactate (venous blood gas; lactate ≥2 mmol/L = sepsis; ≥4 mmol/L = septic shock)
- 6. Monitor urine output (catheterise; target ≥0.5 mL/kg/hour)
In primary care, you may not have IV access or antibiotics immediately available. The priority is: call 999, give oxygen, and if IV access is possible, give IV fluids. Do not delay transfer to initiate all six elements.
Sepsis in Special Populations
Neutropenic Sepsis
Neutropenic sepsis (neutrophils <0.5 × 10⁹/L with fever ≥38°C) in a patient on chemotherapy is a medical emergency. These patients can deteriorate rapidly and may not mount a typical inflammatory response. Any febrile patient on chemotherapy should be treated as neutropenic sepsis until proven otherwise — call 999 immediately.
Sepsis in Pregnancy
Sepsis is a leading cause of maternal mortality. Group A Streptococcus (GAS) is a particularly dangerous pathogen in pregnancy and the postpartum period. Suspect if: fever, uterine tenderness, offensive lochia, tachycardia, or rapid deterioration. Treat as sepsis and arrange emergency obstetric admission.
Key Clinical Takeaways
- Think Sepsis in any acutely unwell patient with suspected infection — do not wait for all criteria
- NEWS2 ≥5: urgent review; NEWS2 ≥7: call 999 and initiate Sepsis Six
- Sepsis Six within 1 hour: O2, cultures, antibiotics, fluids, lactate, urine output
- Do not delay transfer to complete all Sepsis Six elements in primary care
- Neutropenic sepsis in chemotherapy patients: call 999 immediately
- Sepsis in pregnancy: GAS is a leading cause — arrange emergency obstetric admission