Sepsis remains one of the most common critical illnesses managed by emergency medicine and critical care physicians.
Many EDs and ICUs have screening protocols for early detection of the patient with sepsis. Most protocols use the systemic inflammatory response syndrome (SIRS) as a central component of early identification.
A recent study stresses caution when simply using the SIRS criteria to screen for severe sepsis:
Retrospective review of the ANZICS Adult Database
Divided patients into SIRS-positive ( 2 SIRS criteria with at least 1 organ failure) and SIRS-negative ( < 2 SIRS criteria with at least 1 organ failure)
109,663 patients
12% of patients diagnosed with severe sepsis or at least 1 organ failure had < 2 SIRS criteria at admission.
Mortality for the SIRS-negative cohort remained relatively high at 16.1%
Take Home Point
Using the SIRS criteria to screen patients for severe sepsis will miss 1 out of every 8 patients with infection and organ dysfunction.
References
Kaukonen KM, Bailey M, Pilcher D, et al. Systemic Inflammatory Response Syndrome Criteria in Defining Severe Sepsis. NEJM 2015;372:1629-38.
