Sepsis often missed as 50% of screening tools don’t work, study finds

<span>Photograph: James Manning/PA</span>
Photograph: James Manning/PA

Paramedics and A&E doctors often miss signs of sepsis and two of the four ways health professionals screen for the killer condition do not work, a new study claims.

Sepsis, which is often described as blood poisoning, is estimated to be involved in the deaths of about 48,000 people a year in the UK.

Doctors, NHS bosses and health charities have been concerned for years that too many cases go undiagnosed, leaving people badly damaged or dead, because sepsis is so hard to detect.

Unless a patient is diagnosed quickly, their body’s immune system goes into overdrive in response to an infection and then attacks vital tissues and organs. If left untreated, sepsis can cause shock, organ failure and death.

Research from Germany claims to have uncovered significant flaws in two of the four screening tools that health workers use worldwide to identify cases of the life-threatening illness.

The four systems are NEWS2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome).

The researchers analysed records of the care given to 221,429 patients in Germany who were treated by emergency health workers outside hospital settings in 2016.

“Only one of four screening tools had a reasonably accurate prediction rate for sepsis – NEWS2. It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic cases,” they concluded.

Silke Piedmont, a health scientist in the department of emergency medicine at the Universitätsmedizin in Berlin, said: “We found that paramedics never documented a suspicion of sepsis and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases.”

Health workers are much more likely to correctly identify the signs of a heart attack or stroke, which means those patients have a greater chance of survival. Problems in spotting sepsis meant that 31.4% of sepsis patients in the study died within 30 days, compared with 13.4% of those who had had a heart attack and 11.8% of stroke sufferers, said Dr Wolfgang Bauer, a co-author.

The findings, which have not been peer-reviewed and are described as “observational”, are being presented at this week’s European Emergency Medicine Congress in Barcelona.

NHS England stressed that it already deploys NEWS2, which emerged as the best system.

An NHS spokesperson said: “This study shows the NHS actually is using the best screening tool available for detecting sepsis – NEWS2 – and as professional guidance for doctors in England sets out, it is essential that any patient’s wishes to seek a second opinion are respected.”

Steve Barclay, the health secretary, last week announced plans to introduce “Martha’s rule” into the NHS in England. It will give patients and their families the right to seek a second medical opinion if they are unhappy with their diagnosis or treatment.

Martha Mills, 13, died in 2021 after developing sepsis while under the care of King’s College hospital NHS foundation trust in south London.

Dr Adrian Boyle, the president of the Royal College of Emergency Medicine, which represents A&E doctors, said: “Sepsis continues to be fiendishly difficult to diagnose in the early stages. The problem is that the early symptoms are often similar to less serious conditions.

“To reduce the risk of missing this potentially devastating diagnoses, we recommend early assessment by a trained clinician and routine use of early warning scores such as NEWS2.”

We approached the College of Paramedics for their response.