Sepsis Screening Tools in Acute Care: A Comparative Narrative Review of Diagnostic Accuracy, Clinical Performance, and Implementation Effectiveness (2015–2025)
Keywords:
• Sepsis / diagnosis, • Sepsis / mortality, • Critical Illness / diagnosis, • Shock, Septic / diagnosis, • Early Diagnosis, • Severity of Illness Index, • Clinical Decision Rules, • Sensitivity and Specificity, • Receiver Operating Characteristic (ROC) Curve, • Emergency Service, Hospital, • Intensive Care Units, • Quality Improvement, • Electronic Health Records, • Machine Learning, • Alert Systems, Clinical, • Evidence-Based Medicine, • Systematic Reviews as TopicAbstract
Purpose: Sepsis remains a global health emergency with mortality exceeding 20%, yet early recognition and screening remain inconsistent. This narrative review synthesizes evidence on sepsis screening tools and early warning scores for adult patients in acute-care environments.
Scope of literature: A comprehensive search of PubMed, Embase, Scopus, Web of Science, and Cochrane Library (January 2015–December 2025) identified 26+ primary studies, systematic reviews, meta-analyses, and clinical guidelines. Key sources include 62,338-patient meta-analyses, Sepsis-3 consensus1, Surviving Sepsis Campaign 2021 guidelines, and recent ED implementation trials.
Key themes: (1) No single screening tool offers optimal sensitivity and specificity; (2) qSOFA excels as a mortality predictor but lacks screening sensitivity; (3) NEWS and MEWS provide balanced early warning; (4) SIRS remains too nonspecific for sepsis; (5) combining tools with lactate or capillary refill improves diagnostic accuracy; (6) electronic alert systems reduce mortality and improve bundle adherence; (7) resource limitations and setting heterogeneity drive performance variation.
Clinical relevance: Current evidence supports multimodal screening strategies combining bedside vital-sign scores (NEWS/MEWS), organ-dysfunction assessment (qSOFA/SOFA), biochemical markers (lactate), and structured electronic or clinical decision-support pathways embedded in quality-improvement programs. No single score should be used in isolation. Clinicians must balance diagnostic sensitivity with specificity based on local case-mix, infrastructure, and antimicrobial stewardship concerns.
