| Message: The Systemic Inflammatory Response Syndrome (SIRS)
SIRS was defined as fulfilling at least two of the following four criteria:
fever >38.0°C or hypothermia <36.0°C,
tachycardia >90 beats/minute,
tachypnea >20 breaths/minute,
leucocytosis >12*109/l or leucopoenia <4*109/l.
The qSOFA Score was introduced by the Sepsis-3 group as a simplified version of the SOFA Score, a validated ICU mortality prediction score, to help identify patients with suspected infection that are at high risk for poor outcome (defined as in-hospital mortality, or ICU length of stay ≥3 days) outside of the ICU.
Patients with SIRS or sepsis require immediate stabilization and treatment. It is recommended that treatment be centered on fluid resuscitation, antimicrobial therapy, infectious source control, and overall supportive care (e.g., pain control, nutrition).
TRIAGE OF SEPSIS PATIENTS: SIRS OR QSOFA – WHICH IS BEST?
N Gunn, C Haigh, JR Thomson
Abstract
Objectives & Background Recent consensus guidelines have suggested using the qSOFA score as a tool for the identification of patients with sepsis outwith the ICU setting. In the UK, we currently use the SIRS criteria as a means of identifying these patients in the ED. We wanted to look at whether the qSOFA would reliably identify septic patients in our ED population.
Methods We retrospectively reviewed 200 cases of adult patients presenting to our ED over a six month period who had a sepsis 6 form completed. SIRS and qSOFA scores were calculated for all patients and the results compared. Patients identified as requiring critical care input and those who died were noted.
Results 200 patients were identified over a 6 month period–109 male, 91 female; age range 18–95 yrs; average 66.7 yrs; IQR 1–58 yr; IQR 3–79 yrs.
Of these 200 patients, 4 were admitted to ITU and 17 were admitted to HDU from the Emergency Department. There were 22 deaths in total of whom 1 died on ITU with full escalation of care, and 8 died in HDU with a decision they were not for further escalation. Of those that died outwith critical care, 8 had a decision of ward as ceiling of care made in the ED.
195 cases were positive for SIRS of which 4 were admitted to ICU; 16 to HDU and 22 died. SIRS identified all patients who died and all but 1 patient who received critical care input.
SIRS test was 97% sensitive and 2.4% specific. The positive predictive value is 15.9%, the negative predictive value is 80%.
29 cases were positive for qSOFA of whom 1 was admitted to ICU and 9 to HDU. There were 9 deaths in this group of which 5 were patients on HDU. 4 patients identified as qSOFA positive were determined as not for escalation of care and subsequently died.
qSOFA was 90% specific for identifying patients who died or required critical care input but only 48% sensitive. The positive predictive value is 42%, the negative predictive value is 92%.
Conclusion qSOFA is a more specific test to identify patients requiring critical care input or at risk of death. Although SIRS is more sensitive, its lack of specificity makes it a much less effective screening tool for severe sepsis.
Practically, SIRS is useful as a triage tool to identify potentially septic patients but once identified qSOFA should be used to assess severity and need for critical care involvement.
http://dx.doi.org/10.1136/emermed-2016-206402.23 |
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