The development of SIC-IR to assist with diagnosing infections in critically ill trauma patients: Moving beyond the 'fever workup'

The current work-up of infections in the surgical and trauma intensive care unit (STICU) is inefficient and often based on fever and leukocytosis. Using retrospective data we evaluated our practice of obtaining cultures in the STICU and concluded that physicians order cultures based on fever and/or leukocytosis, yet fever and/or leukocytosis were not associated with positive culture results in critically injured patients within the first 14 days of injury. To challenge and change conventional practice we developed a medical informatics system, SIC-IR(c) (Surgical Intensive Care -- Infection Registry) to be a tool to allow us to further study the infection work-up in the STICU. We validated SIC-IR to be a successful medical informatics tool that archived accurate data. Additionally, we demonstrated that SIC-IR has excellent sensitivity of identifying patients with ventilator associated pneumonia and improves documentation of a patients' severity of illness. Our long term goal is to develop a highly discriminative predictive model to improve the diagnosis of infections in critically ill patients.