Researchers have labelled half the screening tools used by emergency medics to detect sepsis as “inadequate”.

More must be done to support emergency services and to improve existing systems to decrease death rates from blood poisoning, experts said.

A German study explored the effectiveness of four internationally-recommended screening tools for the illness – NEWS-2 (National Early Warning Score), qSOFA (quick Sequential Organ Failure Assessment), MEWS (Modified Early Warning Score) and SIRS (Systemic Inflammatory Response Syndrome).

Using data from 10 health insurance companies, the team collected a cohort of 221,429 patients who were seen by emergency medical services in Germany in 2016 outside of a hospital setting with individual follow-ups in 2016 and 2017.

Documents from paramedics on 110,419 cases from 2016 were also looked at by the team.

Linking the figures together allowed a calculation of the screening tools’ ability to predict sepsis which was found in 4,504 adult cases.

Having said this, only one of the four systems “had a reasonably accurate prediction rate”, researchers said.

NEWS-2 gives a score for illness severity and risk of deterioration and had the highest sensitivity rate at 72.7%.

NEWS was initially developed by the Royal College of Physicians and was updated to NEWS-2 in 2017.

Endorsed by NHS England, it is the screening tool used by all ambulance trusts and 76% of acute trusts.

NEWS-2 was followed by MEWS with a 46.8% sensitivity and SIRS (30.4%).

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The qSOFA system scores patients on their breathing, mental state and blood pressure and it had the lowest sensitivity rate at 24.1% but correctly predicted 96.6% of patients who did not have sepsis.

Silke Piedmont, a health scientist at the Department of Emergency Medicine Campus Benjamin Franklin Charite – Universitatsmedizin 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.

“The screening tools recommended in the Surviving Sepsis Campaign guidelines differed greatly in terms of which and how many patients were identified as possibly having sepsis.”

How many people die from sepsis each year in England?

According to Health Education England, there are about 123,000 cases of sepsis each year in England with about 36,800 associated deaths.

The findings will be presented at the European Emergency Medicine Congress (EUSEM 2023) and it’s hoped they could apply to other countries and work towards the development of new guidelines on sepsis screening.

Mrs Piedmont added: “The incidence and death rates for sepsis and the low recognition of it emphasise the need for better awareness and more frequent use of screening tools.

“No screening tool provides ideal performance.

“Ours is the first study comparing all four screening tools and showing the predictive usefulness of applying the screening tools to all adult patients independently of any presumptions or preliminary diagnoses by emergency medical services.”

What is Martha’s rule?

The study comes after the UK Government committed to implementing “Martha’s rule” in England.

Merope Mills’ daughter Martha died in 2021 aged 13 after developing sepsis while under the care of King’s College Hospital NHS Foundation Trust in south London.

The rule will give patients the right to a second opinion if they believe their concerns are being dismissed by NHS staff.

Professor Youri Yordanov, chairman of the EUSEM 2023 abstract committee, said: “Sadly, we too often see patients being brought into hospital emergency departments with advanced sepsis.

“Some of them we can save, but unfortunately some will die who could have been saved if they had received treatment at an earlier stage.

“Emergency services need tools that can help them quickly and accurately predict that a patient may have sepsis and should be investigated further in hospital.

“This study shows that more needs to be done to develop such tools and improve the existing ones. Only then will we be able to bring down the death rates from sepsis.”

What causes sepsis?

Sepsis is “a life-threatening reaction to an infection” and “happens when your immune system overreacts to an infection and starts to damage your body's own tissues and organs”, the NHS website explains.

It’s sometimes called septicaemia or blood poisoning.

What are the symptoms of sepsis?

People who have sepsis may experience a range of symptoms including flu or a chest infection.

Other symptoms include slurred speech, difficulty breathing, a rash that doesn’t vanish when you put a glass on it and blue, grey, pale or botchy skin, lips or tongue.

Find out more about sepsis and when you should call 999 or go to A&E via the NHS website.