NEWS2 versus shock status to stratify antibiotic urgency in patients with suspected sepsis: a retrospective, multicentre cohort study.

Summary

In 99,667 encounters across nine hospitals, each additional hour to antibiotic administration was associated with higher mortality in patients with shock and in those with NEWS2+ scores of at least 7. Importantly, high NEWS2 identified many non-shock patients in whom delays were also associated with mortality, whereas no such association was observed at lower NEWS2 scores.

Key Findings

• The final cohort included 99,667 encounters from 71,593 patients across nine hospitals, including 4,867 encounters with shock.
• Each additional hour of antibiotic delay was associated with mortality in shock encounters (adjusted odds ratio 1.15) and in encounters with NEWS2+ of at least 7 (adjusted odds ratio 1.07).
• Among patients without shock, 22,902 of 26,551 encounters with NEWS2+ of at least 7 showed a mortality-associated antibiotic delay, while lower NEWS2 categories did not.

Clinical Implications

Emergency and hospital protocols could consider incorporating NEWS2, particularly a score of 7 or higher, into antibiotic-timing pathways rather than relying exclusively on shock status. Implementation should be accompanied by antimicrobial stewardship and prospective evaluation to avoid unnecessary antibiotic exposure in patients without bacterial infection.

Limitations

• The retrospective design can identify associations but cannot prove that shortening antibiotic delays would causally reduce mortality.
• The cohort came from one US health-care system and excluded several patient groups, which may limit generalizability to other settings and populations.

Future Directions

Prospective implementation studies should test NEWS2-guided antibiotic pathways, evaluate effects on mortality and antibiotic overuse, and compare NEWS2 with other early-warning and sepsis-screening systems across diverse hospitals.