Suspected sepsis:
recognition, diagnosis and
early management
NICE guideline
Published: 13 July 2016
Last updated: 19 March 2024
www.nice.org.uk/guidance/ng51
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights).
,Suspected sepsis: recognition, diagnosis and early management (NG51)
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful
consideration of the evidence available. When exercising their judgement, professionals
and practitioners are expected to take this guideline fully into account, alongside the
individual needs, preferences and values of their patients or the people using their service.
It is not mandatory to apply the recommendations, and the guideline does not override the
responsibility to make decisions appropriate to the circumstances of the individual, in
consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment
or in a procedure should be reported to the Medicines and Healthcare products Regulatory
Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the
guideline to be applied when individual professionals and people using services wish to
use it. They should do so in the context of local and national priorities for funding and
developing services, and in light of their duties to have due regard to the need to eliminate
unlawful discrimination, to advance equality of opportunity and to reduce health
inequalities. Nothing in this guideline should be interpreted in a way that would be
inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally
sustainable health and care system and should assess and reduce the environmental
impact of implementing NICE recommendations wherever possible.
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 2 of
conditions#notice-of-rights). 95
,Suspected sepsis: recognition, diagnosis and early management (NG51)
Contents
Overview ...................................................................................................................................... 6
Who is it for? .......................................................................................................................................... 6
Could this be sepsis? .................................................................................................................. 7
1.1 When to suspect sepsis................................................................................................................... 7
1.2 People who are most vulnerable to sepsis ................................................................................... 9
Face to face assessment ............................................................................................................ 12
1.3 Initial assessment and examination ............................................................................................... 12
1.4 Interpreting findings ........................................................................................................................ 14
Under 16s: evaluating risk and managing suspected sepsis .................................................. 16
1.5 Evaluating risk level ......................................................................................................................... 16
1.6 Managing suspected sepsis outside acute hospital settings ..................................................... 23
1.7 Managing suspected sepsis in acute hospital settings ............................................................... 25
Pregnant or recently pregnant people: evaluating risk and managing suspected sepsis....33
1.8 Evaluating risk level ......................................................................................................................... 33
1.9 Managing suspected sepsis outside acute hospital settings ..................................................... 34
1.10 Managing suspected sepsis in acute hospital settings.............................................................. 36
Over 16s (not pregnant or recently pregnant): evaluating risk and managing suspected
sepsis ............................................................................................................................................ 42
1.11 Evaluating risk level ........................................................................................................................ 42
1.12 Managing suspected sepsis outside acute hospital settings .................................................... 45
1.13 Managing suspected sepsis in acute hospital settings ............................................................. 50
Antibiotic therapy, intravenous fluid and oxygen ..................................................................... 61
1.14 Choice of antibiotic therapy for people with suspected sepsis ................................................ 61
1.15 Intravenous fluids for people with suspected sepsis ................................................................. 63
1.16 Using oxygen for people with suspected sepsis ........................................................................ 65
Finding and controlling the source of infection ........................................................................ 66
1.17 Everyone ......................................................................................................................................... 66
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 3 of
conditions#notice-of-rights). 95
, Suspected sepsis: recognition, diagnosis and early management (NG51)
1.18 Children aged 3 months or less .................................................................................................... 67
Information and support for all people with suspected sepsis ............................................... 68
1.19 Communicating and sharing information ..................................................................................... 68
1.20 People who have sepsis and their families and carers.............................................................. 69
1.21 Information at discharge for people assessed for suspected sepsis, but not diagnosed
with sepsis ............................................................................................................................................. 69
1.22 Information at discharge for people at increased risk of sepsis............................................... 70
1.23 Information at discharge for people who have had sepsis ....................................................... 70
Training and education ............................................................................................................... 72
1.24 Healthcare staff involved in assessing clinical condition .......................................................... 72
1.25 Healthcare professionals involved in triage or early management .......................................... 72
Terms used in this guideline ....................................................................................................... 74
Critical care specialist or team............................................................................................................. 74
Not responding to intravenous fluid resuscitation ............................................................................. 74
Recently pregnant ................................................................................................................................. 74
Sepsis ..................................................................................................................................................... 75
Suspected sepsis .................................................................................................................................. 75
Senior clinical decision maker .............................................................................................................. 75
Recommendations for research ................................................................................................. 76
1 Epidemiological study on presentation and management of sepsis in England .......................... 76
2 Association between NEWS2 bands (0, 1 to 4, 5 to 6, 7 or above) and risk of severe illness or
death ...................................................................................................................................................... 76
3 Derivation of clinical decision rules in suspected sepsis ............................................................... 77
Rationale and impact................................................................................................................... 78
People with neutropenia or immunosuppression ............................................................................... 78
Initial assessment and examination..................................................................................................... 78
Evaluating risk level in people with suspected sepsis in acute hospital settings, acute mental
health settings and ambulances .......................................................................................................... 79
Outside acute hospital settings ........................................................................................................... 81
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 4 of
conditions#notice-of-rights). 95
recognition, diagnosis and
early management
NICE guideline
Published: 13 July 2016
Last updated: 19 March 2024
www.nice.org.uk/guidance/ng51
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-
conditions#notice-of-rights).
,Suspected sepsis: recognition, diagnosis and early management (NG51)
Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful
consideration of the evidence available. When exercising their judgement, professionals
and practitioners are expected to take this guideline fully into account, alongside the
individual needs, preferences and values of their patients or the people using their service.
It is not mandatory to apply the recommendations, and the guideline does not override the
responsibility to make decisions appropriate to the circumstances of the individual, in
consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment
or in a procedure should be reported to the Medicines and Healthcare products Regulatory
Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the
guideline to be applied when individual professionals and people using services wish to
use it. They should do so in the context of local and national priorities for funding and
developing services, and in light of their duties to have due regard to the need to eliminate
unlawful discrimination, to advance equality of opportunity and to reduce health
inequalities. Nothing in this guideline should be interpreted in a way that would be
inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally
sustainable health and care system and should assess and reduce the environmental
impact of implementing NICE recommendations wherever possible.
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 2 of
conditions#notice-of-rights). 95
,Suspected sepsis: recognition, diagnosis and early management (NG51)
Contents
Overview ...................................................................................................................................... 6
Who is it for? .......................................................................................................................................... 6
Could this be sepsis? .................................................................................................................. 7
1.1 When to suspect sepsis................................................................................................................... 7
1.2 People who are most vulnerable to sepsis ................................................................................... 9
Face to face assessment ............................................................................................................ 12
1.3 Initial assessment and examination ............................................................................................... 12
1.4 Interpreting findings ........................................................................................................................ 14
Under 16s: evaluating risk and managing suspected sepsis .................................................. 16
1.5 Evaluating risk level ......................................................................................................................... 16
1.6 Managing suspected sepsis outside acute hospital settings ..................................................... 23
1.7 Managing suspected sepsis in acute hospital settings ............................................................... 25
Pregnant or recently pregnant people: evaluating risk and managing suspected sepsis....33
1.8 Evaluating risk level ......................................................................................................................... 33
1.9 Managing suspected sepsis outside acute hospital settings ..................................................... 34
1.10 Managing suspected sepsis in acute hospital settings.............................................................. 36
Over 16s (not pregnant or recently pregnant): evaluating risk and managing suspected
sepsis ............................................................................................................................................ 42
1.11 Evaluating risk level ........................................................................................................................ 42
1.12 Managing suspected sepsis outside acute hospital settings .................................................... 45
1.13 Managing suspected sepsis in acute hospital settings ............................................................. 50
Antibiotic therapy, intravenous fluid and oxygen ..................................................................... 61
1.14 Choice of antibiotic therapy for people with suspected sepsis ................................................ 61
1.15 Intravenous fluids for people with suspected sepsis ................................................................. 63
1.16 Using oxygen for people with suspected sepsis ........................................................................ 65
Finding and controlling the source of infection ........................................................................ 66
1.17 Everyone ......................................................................................................................................... 66
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 3 of
conditions#notice-of-rights). 95
, Suspected sepsis: recognition, diagnosis and early management (NG51)
1.18 Children aged 3 months or less .................................................................................................... 67
Information and support for all people with suspected sepsis ............................................... 68
1.19 Communicating and sharing information ..................................................................................... 68
1.20 People who have sepsis and their families and carers.............................................................. 69
1.21 Information at discharge for people assessed for suspected sepsis, but not diagnosed
with sepsis ............................................................................................................................................. 69
1.22 Information at discharge for people at increased risk of sepsis............................................... 70
1.23 Information at discharge for people who have had sepsis ....................................................... 70
Training and education ............................................................................................................... 72
1.24 Healthcare staff involved in assessing clinical condition .......................................................... 72
1.25 Healthcare professionals involved in triage or early management .......................................... 72
Terms used in this guideline ....................................................................................................... 74
Critical care specialist or team............................................................................................................. 74
Not responding to intravenous fluid resuscitation ............................................................................. 74
Recently pregnant ................................................................................................................................. 74
Sepsis ..................................................................................................................................................... 75
Suspected sepsis .................................................................................................................................. 75
Senior clinical decision maker .............................................................................................................. 75
Recommendations for research ................................................................................................. 76
1 Epidemiological study on presentation and management of sepsis in England .......................... 76
2 Association between NEWS2 bands (0, 1 to 4, 5 to 6, 7 or above) and risk of severe illness or
death ...................................................................................................................................................... 76
3 Derivation of clinical decision rules in suspected sepsis ............................................................... 77
Rationale and impact................................................................................................................... 78
People with neutropenia or immunosuppression ............................................................................... 78
Initial assessment and examination..................................................................................................... 78
Evaluating risk level in people with suspected sepsis in acute hospital settings, acute mental
health settings and ambulances .......................................................................................................... 79
Outside acute hospital settings ........................................................................................................... 81
© NICE 2024. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- Page 4 of
conditions#notice-of-rights). 95
