Jackson Memorial Hospital Trauma and Acute Care Surgery NEST Scoring Guidelines
Approved – Namias July 2026
NEST 1 (Immediate) –
Life-threatening hemorrhage or other surgical emergency in which benefits of immediate transport to OR outweigh benefits of room setup
NEST 2 (Within 1 hour) –
Sepsis with need for emergent source control; imminent loss of life, bowel, limb
NEST 3 (Within 4 hours) –
Infection with need for urgent source control due to elevated risk for deterioration
NEST 4 (Within 6 hours) –
Infection with need for timely source control (ie acute uncomplicated appendicitis in patient with limited comorbidities)
NEST 5 (Within 12 hours) –
Re-exploration of prior temporary abdominal closure with corrected physiology
NEST 6 (Within 24 hours) –
Planned NSTI reoperations without signs of urgent need for source control
NEST 7 (within 48 hours) –
Acute cholecystitis
Tracheostomy
Gastrostomy
This document is a guideline only. All management including NEST scores should be at the discretion of the attending surgeon. Residents or fellows involved in posting operative cases are expected to specifically confirm the NEST score with the responsible attending. NEST scores may be revised at any time by the on-call attending based on updates in clinical condition.
Description
NEST 1 (Immediate) –
Life-threatening hemorrhage or other surgical emergency in which benefits of immediate transport to OR outweigh benefits of room setup
NEST 2 (Within 1 hour) –
Sepsis with need for emergent source control; imminent loss of life, bowel, limb
NEST 3 (Within 4 hours) –
Infection with need for urgent source control due to elevated risk for deterioration
NEST 4 (Within 6 hours) –
Infection with need for timely source control (ie acute uncomplicated appendicitis in patient with limited comorbidities)
NEST 5 (Within 12 hours) –
Re-exploration of prior temporary abdominal closure with corrected physiology
NEST 6 (Within 24 hours) –
Planned NSTI reoperations without signs of urgent need for source control
NEST 7 (within 48 hours) –
Acute cholecystitis
Tracheostomy
Gastrostomy
This document is a guideline only. All management including NEST scores should be at the discretion of the attending surgeon. Residents or fellows involved in posting operative cases are expected to specifically confirm the NEST score with the responsible attending. NEST scores may be revised at any time by the on-call attending based on updates in clinical condition.