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Three Part Question

Does the [using NEWS triage] of [patients with sepsis] improve [mortality] within the UK

Clinical Scenario

Whilst working in an Emergency Department an adult patients attends and is assessed at triage as having sepsis. The patient receives prompt appropriate treatment. Does the initial triage affect their outcome?

Search Strategy

ProQuest
Sepsis AND triage AND emergency FULL TEXT journals for UK within the last 3 years

Search Outcome

37 articles. 19 selected. 17 excluded due to either paediatric patients or country of origin

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
CORFIELD et al 2014 uk	2003 patients over 3/12 period with complete set of observations in ED	Retrospective observational study Median NEWS score = 7	The positive predictive value illustrates that 27% of patients with a NEWS of ?7 were admitted to the ICU within 2 days and/or died within 30 days. For a NEWS of ?9 this rose to 35%.		Study only looked at sepsis for use of NEWS, and mandated senior doctor review and critical care review.
KEEP et al 2016 UK	27 patients with severe sepsis NEWS of 3 +	Retrospective single centre observational analysis	The positive predictive value is 18.7% (95% CI 12.7% to 26.5%), and the negative predictive value is 99.5% (95% CI 97.8% to 99.9%).		Low sample size, NEWS 3 so excluded lower NEWS scores. Patients analysed in July so may excluded other presentations during other months eg. Winter.

Comment(s)

The two retrospective observational studies demonstrated that early recognition of sepsis has an impact in the management and subsequent mortality of the patients. However there are significant weaknesses in terms of sample size and other factors such as senior review and prompt antibiotics. Further studies would require undertaking to determine whether the prompt recognition and subsequent management of sepsis ensured better patient outcomes.

Clinical Bottom Line

The early recongition of sepsis using NEWS scoring does have an impact on patient care alongside prompt antibiotics and escalation to senior support.

References

1. CORFIELD, A.R., LEES, F., ZEALLEY, I., HOUSTON, G., DICKIE, S., WARD, K. and MCGUFFIE, C., Utility of a single early warning score in patients with sepsis in the emergency department Emergency Medicine Journa 31(6), pp. 482
2. KEEP, J.W., MESSMER, A.S., SLADDEN, R., BURRELL, N., PINATE, R., TUNNICLIFF, M. and GLUCKSMAN National early warning score at Emergency Department triage may allow earlier identification of patients with severe sepsis and septic shock: a retrospective observational study Emergency Medicine Journal 33(1), pp. 37