Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May;15(3):329-36.
doi: 10.5811/westjem.2013.9.18064. Epub 2014 Feb 19.

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department

Timothy Horeczko  1 , Jeffrey P Green  2 , Edward A Panacek  2
Affiliations

Epidemiology of the Systemic Inflammatory Response Syndrome (SIRS) in the emergency department

Timothy Horeczko et al. West J Emerg Med. 2014 May.

Abstract

Introduction: Consensus guidelines recommend sepsis screening for adults with systemic inflammatory response syndrome (SIRS), but the epidemiology of SIRS among adult emergency department (ED) patients is poorly understood. Recent emphasis on cost-effective, outcomes-based healthcare prompts the evaluation of the performance of large-scale efforts such as sepsis screening. We studied a nationally representative sample to clarify the epidemiology of SIRS in the ED and subsequent category of illness.

Methods: This was a retrospective analysis of ED visits by adults from 2007 to 2010 in the National Hospital Ambulatory Medical Care Survey (NHAMCS). We estimated the incidence of SIRS using initial ED vital signs and a Bayesian construct to estimate white blood cell count based on test ordering. We report estimates with Bayesian modified credible intervals (mCIs).

Results: We used 103,701 raw patient encounters in NHAMCS to estimate 372,844,465 ED visits over the 4-year period. The moderate estimate of SIRS in the ED was 17.8% (95% mCI: 9.7 to 26%). This yields a national moderate estimate of approximately 16.6 million adult ED visits with SIRS per year. Adults with and without SIRS had similar demographic characteristics, but those with SIRS were more likely to be categorized as emergent in triage (17.7% versus 9.9%, p<0.001), stay longer in the ED (210 minutes versus 153 minutes, p<0.0001), and were more likely to be admitted (31.5% versus 12.5%, p<0.0001). Infection accounted for only 26% of SIRS patients. Traumatic causes of SIRS comprised 10% of presentations; other traditional categories of SIRS were rare.

Conclusion: SIRS is very common in the ED. Infectious etiologies make up only a quarter of adult SIRS cases. SIRS may be more useful if modified by clinician judgment when used as a screening test in the rapid identification and assessment of patients with the potential for sepsis. [West J Emerg Med. 2014;15(3):329-336.].

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

Figures

Figure.
Figure.
Adults with SIRS and subsequent category of illness based on moderate estimate presenting to United States emergency departments, 2007–2010; N=66,388,686 visits.
See this image and copyright information in PMC

References

    1. Bone RC, Balk RA, Cerra FB. Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis. Chest. 1992;101:1644–1655. et al for the ACCP/SCCM Consensus Conference Committee. - PubMed
    1. Bone RC. Towards an Epidemiology and Natural History of SIRS (Systemic Inflammatory Response Syndrome) JAMA. 1992;268(24):3452–3455. - PubMed
    1. Levy MM, Dellinger RP, Townsend SR et al. The Surviving Sepsis Campaign: results of an international guideline-based performance improvement program targeting severe sepsis. Crit Care Med. 2010;38(2):367–374. - PubMed
    1. Whippy A, Skeath M, Crawford B et al. Kaiser Permanente's performance improvement system, part 3: multisite improvements in care for patients with sepsis. Jt Comm J Qual Patient Saf. 2011;37(11):483–93. p. - PubMed
    1. Joint Commission on Accreditation of Healthcare Organizations. Online Bulletin: Center launches project to reduce sepsis mortality. Joint Commision Online. June 27, 2012. http://www.jointcommission.org/ (Accessed March 20, 2013)

MeSH terms