Sepsis: Early Recognition and Why It Is Still Missed

Evidence-based learning with guided reflection for CPD and revalidation 

Estimated Learning Time: 20 – 30 minutes 

CPD Evidence:

Download the Sepsis Recognition Reflection Template to support your revalidation and CPD

portfolio.

For case-based learning and practical assessment skills, explore our related courses at

Saffron Health Education.

Introduction

Sepsis remains a leading cause of preventable mortality worldwide. Despite national

guidelines and structured screening tools, delays in recognition and escalation continue to

occur across healthcare settings.

The challenge is rarely identifying severe sepsis—it is recognising the early, often non-

specific signs before rapid deterioration develops.

What Is Sepsis?

Sepsis is a life-threatening condition arising from a dysregulated response to infection,

leading to organ dysfunction.

Early identification is critical as outcomes are strongly linked to how quickly sepsis is

recognised and treated.

Early Signs of Sepsis

Early sepsis can present with subtle clinical features, including:

• Increased respiratory rate

• Tachycardia

• Fever or hypothermia

• Altered mental state (confusion, agitation)

• Reduced urine output

• Generalised deterioration or “feeling unwell”

These signs are frequently non-specific and may initially appear mild. However, when

combined or trending, they may indicate early sepsis.

Why Is Sepsis Still Missed?

Despite widespread awareness, several factors contribute to delayed recognition:

• Non-specific early presentation

• Over-reliance on single observations rather than trends

• Failure to link infection with physiological deterioration

• Reassurance from “normal” observations (e.g. oxygen saturation)

• Delays in escalation or senior review

As with general deterioration, these are largely system and training challenges.

The Importance of Trends and Clinical Judgement

Tools such as the National Early Warning Score (NEWS2) support identification of

deterioration. However, they are not diagnostic tools for sepsis.

Clinical concern should always override a low score.

A patient with suspected infection and a rising respiratory rate warrants further

assessment—even if the overall score appears low.

Red Flags for Urgent Action

Immediate escalation is required if any of the following are present:

• Marked tachypnoea

• Hypotension

• New confusion or reduced consciousness

• Lactate elevation (which can be found on a blood gas analysis)

• Signs of organ dysfunction

Delays at this stage significantly increase mortality risk.

Escalation and Early Management

Effective sepsis management depends on:

• Early recognition

• Prompt escalation using local pathways

• Timely initiation of treatment (e.g. antibiotics, fluids)

• Clear communication within the clinical team

Confidence in escalation remains a critical factor. Staff must feel able to act on concern,

even in the absence of definitive signs.

Implications for Practice

Reflect on your clinical environment:

• Are patients with suspected infection routinely assessed for deterioration?

• Are trends in observations reviewed consistently?

• Do early warning scores support or delay decision-making?

• How confident are you in escalating suspected sepsis?

• Can you identify a case where earlier recognition may have changed the outcome?

Key Message

Sepsis is not missed because it is rare—it is missed because early signs are subtle, variable,

and often normalised.

Early recognition, combined with decisive action, remains the most effective intervention.

Key References

• National Institute for Health and Care Excellence (NICE). Sepsis: recognition,

  diagnosis and early management (NG51)

• UK Sepsis Trust. Sepsis screening and management resources

• Royal College of Physicians. NEWS2: Standardising the assessment of acute illness

  severity in the NHS

Download our ready to use CPD Reflections template below.