SIRS and Severe Sepsis Screening

• 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.