title: Systemic inflammatory response syndrome-based severe sepsis screening algorithms in emergency department patients with suspected sepsis.
abstract: OBJECTIVE
  Systemic inflammatory response syndrome (SIRS)-based severe sepsis screening algorithms have been utilised in stratification and initiation of early broad spectrum antibiotics for patients presenting to EDs with suspected sepsis. We aimed to investigate the performance of some of these algorithms on a cohort of suspected sepsis patients.
  
  
  METHODS
  We conducted a retrospective analysis on an ED-based prospective sepsis registry at a tertiary Sydney hospital, Australia. Definitions for sepsis were based on the 2012 Surviving Sepsis Campaign guidelines. Numerical values for SIRS criteria and ED investigation results were recorded at the trigger of sepsis pathway on the registry. Performance of specific SIRS-based screening algorithms at sites from USA, Canada, UK, Australia and Ireland health institutions were investigated.
  
  
  RESULTS
  Severe sepsis screening algorithms' performance was measured on 747 patients presenting with suspected sepsis (401 with severe sepsis, prevalence 53.7%). Sensitivity and specificity of algorithms to flag severe sepsis ranged from 20.2% (95% CI 16.4-24.5%) to 82.3% (95% CI 78.2-85.9%) and 57.8% (95% CI 52.4-63.1%) to 94.8% (95% CI 91.9-96.9%), respectively. Variations in SIRS values between uncomplicated and severe sepsis cohorts were only minor, except a higher mean lactate (>1.6 mmol/L, P < 0.01).
  
  
  CONCLUSIONS
  We found the Ireland and JFK Medical Center sepsis algorithms performed modestly in stratifying suspected sepsis patients into high-risk groups. Algorithms with lactate levels thresholds of >2 mmol/L rather than >4 mmol/L performed better. ED sepsis registry-based characterisation of patients may help further refine sepsis definitions of the future.
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.|NHMRC Centre for Research Excellence in Critical Infection, Westmead Millennium Institute, Sydney, New South Wales, Australia.
authors.forename: Amith L
authors.initials: AL
authors.lastname: Shetty
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Tristam
authors.initials: T
authors.lastname: Brown
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Tarra
authors.initials: T
authors.lastname: Booth
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Kim Linh
authors.initials: KL
authors.lastname: Van
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Daphna E
authors.initials: DE
authors.lastname: Dor-Shiffer
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Milan R
authors.identifier: http://orcid.org/0000-0003-0128-4757
authors.initials: MR
authors.lastname: Vaghasiya
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: Cassanne E
authors.initials: CE
authors.lastname: Eccleston
authors.affiliation: Westmead Hospital Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia.|NHMRC Centre for Research Excellence in Critical Infection, Westmead Millennium Institute, Sydney, New South Wales, Australia.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Iredell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D012042:Registries; D012189:Retrospective Studies; D018805:Sepsis / Q000175:diagnosis*; D018746:Systemic Inflammatory Response Syndrome / Q000175:diagnosis*
keywords: algorithm; anti-bacterial agent; sensitivity and specificity; severe sepsis; systemic inflammatory response syndrome