New Research Shows Bedside Vital Sign Scores Can Guide Antibiotic Timing for Sepsis Patients

A retrospective study of nearly 100,000 U.S. emergency patients suggests that the National Early Warning Score (NEWS2), which tracks routine bedside vital signs, can guide the timing of antibiotics for suspected sepsis. For patients scoring 7 or higher, each hour of delay was associated with increased mortality, even if they did not have septic shock. Conversely, earlier antibiotics showed no survival benefit for lower-scoring patients, offering clinicians a practical tool to reduce unnecessary antibiotic use.

NEWS2 score for antibiotic timing

• ▪The National Early Warning Score (NEWS2) calculates risk by assigning points to routinely collected bedside vital signs, including respiratory rate, oxygen saturation, blood pressure, pulse, consciousness, and temperature.
• ▪A retrospective study of nearly 100,000 adults suggests the National Early Warning Score (NEWS2) can help clinicians determine which patients with suspected sepsis require immediate antibiotics.

Sepsis diagnostic uncertainty

• ▪Diagnosing sepsis early is difficult because its symptoms overlap with noninfectious illnesses, and there is no gold-standard diagnostic test.
• ▪Administering immediate broad-spectrum antibiotics to all patients with suspected sepsis exposes those with noninfectious illnesses to drug side effects and contributes to global antibiotic resistance.

Treatment delay mortality associations

• ▪Among patients with National Early Warning Score (NEWS2) scores of 7 or higher, each additional hour of delay before receiving antibiotics was associated with increased mortality.
• ▪Among patients with National Early Warning Score (NEWS2) scores below 7, earlier antibiotic treatment was not associated with improved survival.

Study methodology across nine hospitals

• ▪The sepsis study was observational and retrospective, meaning it cannot prove that earlier antibiotic treatment directly caused the observed differences in patient survival.
• ▪Researchers analyzed electronic health record data from 2015 to 2024 for nearly 100,000 adults treated for suspected infection in emergency departments across nine U.S. hospitals.

International guideline comparison

• ▪Many patients with National Early Warning Score (NEWS2) scores of 7 or higher did not have septic shock but still faced worse outcomes from antibiotic delays.
• ▪The study compared the United Kingdom's recommendation to use the National Early Warning Score (NEWS2) against the Surviving Sepsis Campaign's strategy of prioritizing patients in septic shock.