NEWS2 Score May Guide Antibiotic Decisions in Suspected Sepsis

A doctor in an emergency department faces a familiar dilemma: a patient arrives with signs that could mean sepsis, but could just as easily signal something else entirely. Start antibiotics now and risk exposing someone to unnecessary drugs and their side effects. Wait for more information and risk losing precious time if this is truly a life-threatening infection. A new study suggests there may be a better way to navigate that choice.

Researchers analyzing nearly 100,000 patient records from nine American hospitals between 2015 and 2024 found that a simple scoring system—one already in use across many healthcare systems worldwide—could help clinicians make smarter decisions about when to treat aggressively and when to hold back. The National Early Warning Score, or NEWS2, calculates risk based on vital signs that nurses and doctors already measure routinely: heart rate, blood pressure, temperature, breathing rate, oxygen levels, and consciousness. The study, published in The Lancet Respiratory Medicine in early August, suggests this score may be more useful than current practice for identifying which patients truly need immediate antibiotics.

The problem NEWS2 might solve is real and consequential. Sepsis kills quickly when it's genuine, but its early symptoms mimic dozens of other serious conditions. Many patients admitted to hospitals with suspected sepsis turn out to have infections that aren't bacterial, or no infection at all. Giving them antibiotics anyway exposes them to side effects, allergic reactions, and contributes to the growing crisis of antibiotic resistance. Yet hesitating when a patient actually has sepsis can be fatal. International guidelines have tried to thread this needle by recommending immediate antibiotics only for patients showing septic shock—the most severe form—but researchers at Harvard Pilgrim Health Care Institute wondered whether that approach was leaving some high-risk patients behind.

The study's central finding was straightforward: among patients with NEWS2 scores of 7 or higher, every hour of delay before receiving antibiotics was associated with increased mortality. But here's what made the finding significant: many of these high-risk patients did not have septic shock. They looked sick according to their vital signs, but they hadn't yet progressed to the point of organ failure that defines septic shock. Meanwhile, patients with lower NEWS2 scores showed no survival benefit from getting antibiotics quickly. This suggests that NEWS2 could identify a broader group of patients who genuinely need urgent treatment than septic shock alone would catch, while also giving clinicians confidence to take more time evaluating lower-risk patients.

Chanu Rhee, the study's lead author and an associate professor at Harvard Medical School, framed the challenge plainly: clinicians must decide whether to treat before they know for certain whether a patient has a serious bacterial infection. "Our study suggests that NEWS2, a simple early warning score based on routinely measured bedside parameters, can help identify the patients most likely to benefit from immediate treatment—including many beyond those with septic shock—while allowing clinicians greater confidence to take additional time evaluating lower-risk patients."

The research compared two competing international strategies. The United Kingdom's health system recommends using NEWS2 to guide antibiotic urgency in suspected sepsis. The Surviving Sepsis Campaign, influential globally, emphasizes identifying septic shock. This was the first large study to pit these approaches against each other using real patient data. The findings suggest NEWS2 offers a more nuanced framework—not a binary choice between treating everyone immediately or waiting for septic shock to develop, but a graduated response based on how sick a patient actually appears.

Michael Klompas, the study's senior author and a professor of population medicine at Harvard Medical School, called the question the study addressed "one of the most important unanswered questions in sepsis." He suggested NEWS2 could provide "an objective and practical way to identify those patients using a simple bedside score that is already routinely used in clinical practice." The score requires no special equipment or laboratory tests—just the vital signs any nurse can obtain in minutes.

The researchers were careful to note the study's limitations. It was observational, meaning it cannot prove that earlier antibiotics directly caused better survival—only that the two were associated. Patients with higher NEWS2 scores might have had other unmeasured advantages, or the relationship might be more complex than the data can show. Additional studies in different healthcare settings will be needed to confirm whether NEWS2 should become standard practice for guiding antibiotic decisions in emergency departments worldwide. But the findings suggest a path forward: a simple, objective tool that could reduce unnecessary antibiotic exposure while ensuring that truly sick patients get treated without delay.