What are the key clinical signs and symptoms to recognize sepsis in adults during a primary care consultation?

Key clinical signs and symptoms to recognize sepsis in adults during a primary care consultation include:

• Symptoms or signs indicating possible infection, including non-specific or non-localised presentations such as feeling very unwell without necessarily having a high temperature.
• New-onset abnormalities of behaviour, such as confusion or reduced level of consciousness.
• Signs of abnormal circulation, including low blood pressure (systolic <90 mmHg), mottled or ashen appearance, cyanosis of the skin, lips or tongue, and prolonged capillary refill time.
• Respiratory abnormalities such as increased respiratory rate or reduced oxygen saturation.
• Fever or rigors reported by the patient or family/carers, although absence of fever does not exclude sepsis.
• Any breach of skin integrity (cuts, burns, skin infections) or rash suggestive of infection, including non-blanching petechial or purpuric rash.
• Reduced urine output or infrequent urination over the past 18 hours.
• Consideration of risk factors that increase vulnerability to sepsis, such as recent pregnancy, immunosuppression, or recent systemic anticancer treatment.

Assessment should include measurement of temperature, heart rate, respiratory rate, blood pressure, oxygen saturation, and level of consciousness in adults aged 12 or over. Use of an early warning score such as NEWS2 is recommended to stratify risk if sepsis is suspected.

Pay particular attention to concerns expressed by the person or their family/carers about changes from usual behaviour or condition.

In summary, sepsis suspicion arises from a combination of signs of infection plus new abnormalities in behaviour, circulation, or respiration, even if fever is absent.

References: ¹,²