Abstract
Objective
Evaluation of the usefulness of criteria for systemic inflammatory response syndrome (SIRS) compared with the final diagnosis of infection in patients admitted to the emergency room of two university-based hospitals.
Design
Longitudinal cohort study.
Setting
Hospital Universitario San Vicente de Paul and Hospital General de Medellín, Medellín, Colombia.
Patients
Seven hundred thirty-four patients with suspected infection as main diagnosis for admittance into the emergency room.
Measurements and results
Sensitivity, specificity, predictive values and likelihood ratios (LR) of SIRS criteria at admission were determined using, as gold standards, the diagnosis at the time of discharge based on clinical history and evolution, and microbiological confirmation of infection. SIRS criteria were met by 503 patients (68.5%); the discharge diagnosis of infection was found in 657 (89.4%) and 276 (37%) had microbiological confirmation. SIRS criteria exhibited a sensitivity of 69%, specificity of 35%, positive predictive value (PPV) of 90%, negative predictive value (NPV) of 12% and positive LR of 1.06. There were no differences between the two gold standards.
Conclusions
The finding of two or more SIRS criteria was of little usefulness for diagnosis of infection. It is necessary to work with new criteria and probably with biological markers, in order to obtain a simple, precise and operative definition of the sepsis phenomenon.
References
American College of Chest Physician/Society of Critical Care Medicine Consensus Conference: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis (1992). Crit Care Med 20:864–874
Miller PR, Munn DD, Meredith JW, Chang MC (1999) Systemic inflammatory response syndrome in the trauma intensive care unit: who is infected? J Trauma 47:1004–1008
Bossink AW, Groeneveld AB, Hack CE, Thijs LG (1999) The clinical host response to microbial infection in medical patients with fever. Chest 116:380–390
Vincent JL (1997) Dear SIRS, I´m sorry to say that I don´t like you... Crit Care Med 25:372–374
Abraham E, Matthay MA, Dinarello CA, Vincent JL, Cohen J, Opal SM, Glauser M, Parsons P, Fisher CJ Jr, Repine JE (2000) Consensus conference definitions for sepsis, septic shock, acute lung injury and acute respiratory distress syndrome: time for a reevaluation. Crit Care Med 28:232–235
Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP (1995) The natural history of the systemic inflammatory response syndrome (SIRS). JAMA 273:117–123
Muckart DJ, Bhagwanjee S (1997) American College of Chest Physician/Society of Critical Care Medicine Consensus Conference definitions of the systemic inflammatory response syndrome and allied disorders in relation to critically injured patients. Crit Care Med 25:1789–1795
Carlet J (1999). Rapid diagnostic methods in the detection of sepsis. Infect Dis Clin North Am 13:483–494
Vargas A, Quintero C, Jaimes FA, Garcés J, Cuervo J, Ramírez F, Ramírez JH (2000) Atención inicial en pacientes admitidos con criterios de SRIS a hospitales de tercer nivel. IATREIA 13:206–214
Acknowledgements
We are indebted to the staff of emergency services at Hospital San Vicente de Paul and Hospital General de Medellin for their collaboration. Acknowledgements to María Teresa Rugeles and Rodolfo Dennis for suggestions and manuscript review.
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This study was carried out at the Department of Internal Medicine, School of Medicine, University of Antioquia, Medellin, Colombia, and was support by CODI, University of Antioquia
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Jaimes, F., Garcés, J., Cuervo, J. et al. The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room. Intensive Care Med 29, 1368–1371 (2003). https://doi.org/10.1007/s00134-003-1874-0
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DOI: https://doi.org/10.1007/s00134-003-1874-0