| Background. Shock and sepsis are serious medical conditions associated with inadequate tissue perfusion. If the conditions are not diagnosed and treated promptly, a deadly chain of chemical reactions results in multi-organ failure and death. Reports estimate that up to 60% of septic patients present first in the Emergency Department (ED) and studies have shown that early identification of sepsis utilizing systemic inflammatory response (SIRS) criteria can improve survival. However little is known about the incidence of SIRS and sepsis in the ED. In addition, it has yet to be determined how best to identify ED patients who show early signs of either SIRS or sepsis.;Objective. Thus the overall goal of the study is to describe the incidence of individual SIRS criteria, describe current time to SIRS related treatment and to identify early demographic and clinical correlates of SIRS and sepsis diagnoses in the ED setting.;Methods. The study design was descriptive and correlational, utilizing data at one academic, level III hospital and one community, level II hospital in Los Angeles, CA. A random sample of 556 individuals was used to identify incidence and time to treatment data. A random sub-sample of 130 individuals, half with SIRS and half non-SIRS, matched for age and gender, was reviewed to identify early demographic and clinical correlates of SIRS. Using a data collection tool, demographic and physiologic variables were recorded and analyzed. These include age, temperature, heart rate, respiratory rate, white blood cell count, blood pressure, mental status, presumed infection, lactate levels and presence of a SIRS diagnosis.;Results. Incidence of triggers occurred 779 times in the first six hours of presentation to the ED, of which only 37 were treated with SIRS related treatment. Of the 11 most robust variables used in the logistic regression, elevated respiratory rate, elevated temperature and altered mental status, significantly correlated with later development of SIRS, p < .000 (odds ratio [OR], 92.250; 95% confidence interval [CI], 16.317-521.535), p < 041 (OR, 9.624; 95% CI, 1.096-84.505) and p < .016 (OR, .660; 95% CI, .471-.925) respectively.;Conclusion. Incidence of individual SIRS criteria in the ED occurs at a rate that warrants increased screening and the evidence of demographic and physiologic correlates of SIRS diagnosis seen in this study will set the foundation for future studies and influence development of hospital systems and delivery of care models for sepsis. |
