Diagnosing Sepsis in Primary Care: Navigating Clinical Uncertainty Across Vulnerable Patient Groups

Area of Science:

• Medical Diagnostics
• Primary Care Medicine
• Infectious Disease Management

Background:

• Sepsis is a life-threatening medical emergency causing organ dysfunction due to a dysregulated host response to infection.
• It poses a major patient safety challenge in the UK, with rising hospital admissions and significant preventable mortality.
• Most sepsis cases originate in the community, making early recognition by general practitioners (GPs) crucial.

Purpose of the Study:

• To examine the diagnostic challenges UK GPs face in recognizing sepsis, particularly in vulnerable patient groups.
• To review the evidence base for sepsis diagnosis in primary care and assess the applicability of existing tools.
• To identify barriers to timely sepsis diagnosis in general practice and propose solutions.

Main Methods:

• A narrative review of published literature from 2015 to 2025.
• Analysis of current UK guidelines, including NICE guidelines (NG253, NG254, NG255) and UK Sepsis Trust resources.
• Focus on diagnostic challenges in vulnerable populations (elderly, children, multimorbid) presenting with atypical symptoms.

Main Results:

• Most GPs (up to 98%) rely on clinical intuition ('gut feeling') rather than validated screening tools like quick Sequential Organ Failure Assessment (qSOFA) or National Early Warning Score 2 (NEWS2).
• Awareness and use of formal diagnostic tools and UK Sepsis Trust criteria are low (<10% for qSOFA).
• Barriers include short consultations, low sepsis prevalence, increased remote consultations, and limited point-of-care testing.

Conclusions:

• Sepsis recognition in UK general practice is a high-stakes challenge due to atypical presentations in vulnerable patients and systemic barriers.
• Updated NICE guidance emphasizes clinical judgment but implementation is inconsistent.
• Improved GP training, guideline awareness, and primary care-validated diagnostic tools are essential to reduce community-originating sepsis mortality.