The systemic inflammatory response syndrome (SIRS) to identify infected patients in the emergency room

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.