Systemic Inflammatory Response Syndrome

Aka: Systemic Inflammatory Response Syndrome, SIRS

advertisement

II. Indications

  1. Sepsis Evaluation (replaced by SOFA Score and qSOFA Score as of 2016)

III. Background

  1. SIRS suggests an inflammatory response
  2. SIRS is a screening tool for Sepsis
    1. High Test Sensitivity for Sepsis
    2. Poor Test Specificity for Sepsis (any inflammation can cause SIRS)
  3. Sepsis is present when infection accompanies at least 2 positive SIRS criteria
    1. Significance of this definition of Sepsis is that it is correlated with a higher mortality risk than infection without SIRS

IV. Efficacy

  1. Sepsis Test Sensitivity: 50-60%
    1. Fails to identify one in eight patients admitted to ICU with severe Sepsis
    2. Tusgul (2017) Scand J Trauma Resusc Emerg Mefd 25(1):108 [PubMed]
    3. Kaukonen (2015) N Engl J Med 372(17): 1629-38 [PubMed]

V. Criteria: Adults (Positive if 2 of the 4 signs are present)

  1. Body Temperature < 36 C (96.8 F) or > 38 C (100.4 F)
  2. Heart Rate >90 bpm
  3. Tachypnea (>20 breaths per minute) or PaCO2 <32 mmHg
  4. White Blood Cell Count <4000 cells/mm3 or >12,000 cells/mm3 or >10% immature Neutrophils (Band Neutrophils)

VI. Criteria: Children (Positive if 2 of the 4 signs are present)

  1. Major (at least one of these must be present)
    1. Core Temperature >38.5 C (101.3 F) or <36 C (96.8 F)
    2. Leukocyte count elevated or depressed for age or >10% immature Neutrophils (Band Neutrophils)
      1. Abnormal Leukocyte count not due to Chemotherapy
  2. Minor
    1. Tachypnea
      1. Mean Respiratory Rate >2 SD above normal for age or
      2. Mechanical Ventilation for acute reason not related to underlying neuromuscular disorder or general Anesthesia
    2. Abnormal Heart Rate
      1. Tachycardia
        1. Mean Heart Rate 2 SD above normal for age or unexplained persistent elevation for at least 0.5 hours
        2. Not due to external or painful stimuli, longterm medication use
      2. Bradycardia in children <1 year of age
        1. Mean Heart Rate <10th percentile for age or unexplained persistent depression for at least 0.5 hours
        2. Not due to external Vagal Stimulation, Beta Blockers or Congenital Heart Disease

VII. Signs: Children - SIRS Criteria Vital Signs

  1. Age <1 week
    1. Heart Rate >180 or <100 per minute
    2. Respiratory Rate >50 per minute
    3. White Blood Cell Count >34k
  2. Age 1 to 4 weeks
    1. Heart Rate >180 or <100 per minute
    2. Respiratory Rate >40 per minute
    3. White Blood Cell Count >19.5k or <5.5k
  3. Age 1 to 24 months
    1. Heart Rate >180 or <90 per minute
    2. Respiratory Rate >34 per minute
    3. White Blood Cell Count >17.5k or <5.5k
  4. Age 2 to 6 years
    1. Heart Rate >140 per minute
    2. Respiratory Rate >22 per minute
    3. White Blood Cell Count >15.5k or <6k
  5. Age 6 to 13 years
    1. Heart Rate >130 per minute
    2. Respiratory Rate >18 per minute
    3. White Blood Cell Count >13.5k or 4.5k
  6. Age 13 to 18 years
    1. Heart Rate >110 per minute
    2. Respiratory Rate >14 per minute
    3. White Blood Cell Count >11k or <4.5k

VIII. Differential Diagnosis

  1. Infection (Sepsis)
    1. Bacterial Infection (most common)
    2. Also fungal, parasitic or Viral Infection
  2. Trauma
  3. Burn Injury
  4. Post-surgery
  5. Pancreatitis
  6. Pulmonary Embolism
  7. Anaphylaxis
  8. Drug Overdose
  9. Vasculitis
  10. Autoimmune syndrome

IX. References

  1. Khoujah (2013) Crit Dec Emerg Med 27(4):12-21
  2. Annane (2005) Lancet 365(9453): 63-78 [PubMed]
  3. Bone (1992) Chest 101:1644-55 [PubMed]
  4. Goldstein (2005) Pediatr Crit Care Med 6:2-8 [PubMed]

Images: Related links to external sites (from Bing)

These images are a random sampling from a Bing search on the term "Systemic Inflammatory Response Syndrome." Click on the image (or right click) to open the source website in a new browser window. Search Bing for all related images

Related Studies

Related Topics in Examination

advertisement