A low score: what the threshold does not exclude
Educational use only. Not clinically reviewed81-year-old woman for calm observation recording, evidence-boundary review, escalation on concern, and handoff practice. About 8 simulated minutes.
What you will practise
- Reconcile observations that are entirely correct.
- Recognize that a screen is not a rule-out test.
- Escalate on recorded concern, not on the threshold.
- Review the boundaries and their certainty.
- Record a family report as evidence in its own words.
- Hand off a concern that outlived the shift.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Prytz M, et al. Diagnostic accuracy of NEWS2 for sepsis among patients with bacteraemia. APMIS. 2025;133(12):e70129. Sensitivity of a NEWS2 of 5 or more for sepsis 86.6% (95% CI 83.0-89.7), specificity 51.5%; approximately 13% of patients with sepsis and a positive blood culture scored below 5. The authors state that a NEWS2 below 5 cannot definitively rule out sepsis.
- Evans L, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Strong recommendation against using qSOFA compared with SIRS, NEWS, or MEWS as a single screening tool for sepsis or septic shock, on moderate-quality evidence.
- Difonzo M. Performance of the Afferent Limb of Rapid Response Systems in Managing Deteriorating Patients: A Systematic Review. Crit Care Res Pract. 2019;2019:6902420. Afferent limb failure and delayed activation are common; staff believed the situation was under control in 51.8% of missed activations, and calling a physician rather than the response team was the more frequent first action.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.