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Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. by R2 黃信豪. The background (1).
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Systemic inflammatory response syndrome score at admission independently predicts mortality and length of stay in trauma patients. by R2黃信豪
The background (1) • The systemic inflammatory response syndrome (SIRS) was defined by the American College of Chest Physicians and the Society of Critical Care Medicine in 1992. • The syndrome was diagnosed if 2 or more the following criteria are met：
The background (2) • The SIRS criteria ( score )： (1) Temp.greater than 38 degree C or less than 36 degree C (2) Heart rate greater than 90 beats per minute (3) respiratory rate greater than 20/min or PaCO2 less than 32 mmHg (4) WBC greater than 12,000 or less than 4, 000 or presence of more than 10 immature bands
The background (3) • Several recent studies have shown that the score are useful as a severity-of –illness scoring system for hospitalized patients, emergency patients, and critically ill surgical patients： 1. Asayama and Aikawa evaluated SIRS score as a predictor of outcome in emergency patients, and have clinical and prognostic importance in the management of emergency patients.
The background (4) 2. Talmor’s study determined that the SIRS score on the second ICU day predicted mortality and correlated well with the admission APACHE III score and incidence of multiple organ dysfunction (MOD). 3. Afessa’s study reported that SIRS occurs in 27% of patients admitted for gastrointestinal bleeding and is associated with a poor prognosis.
The background (5) • Because of no studies have examined SIRS as a predictor of outcome in trauma patients, the present study was performed to determine whether SIRS score are clinically useful as a simple and rapid means of predicting mortality and the length of hospitalization.
The patients and methods (1) • 4887 trauma admissions to the R. Adams Cowley Shock Trauma Center form January 1, 1997 to July 1, 1998 were analyzed. • The Injury Severity Score (ISS) was used to quantify the extent and severity of an individual’s injuries.
The patients and methods (2) • The SIRS score was calculated at admission for each patient in one point for each component present. • The admission SIRS score was evaluated as an independent predictor of mortality and length of hospitalization by Chi-Square distribution.
The discussion (1) • The initial interest in SIRS in critical illness was based on the progression form SIRS to sepsis, and septic shock in infected patients. • The SIRS were established in 1992 by evaluated the epidemiology and natural history of SIRS after new definitions for sepsis.
The discussion (2) • The mortality rates of patients with SIRS versus sepsis or septic shock were significantly different. • The presence of SIRS was associated with increased mortality in patients being treated for presumed bacteremia.
The discussion (3) • More recent studies have focused on the validity of SIRS as a predictor of outcome in non-infected patients. • According to the Haga’s study, that SIRS is a useful criterion for the recognition of postoperative complications and end-organ dysfunction, and early recovery from SIRS may arrest the progression of organ dysfunction.
The discussion (4) • The study performed by Asayama and Aikawa showed that the mortality of SIRS increased sequentially , rising from 1.4% in patients without SIRS to 35.3% when all four criteria were met. • The second study by this group showed that mortality rate for patients who had 3 or more consecutive days of SIRS was significantly higher than that for patients with less than 3 consecutive days of SIRS.
The discussion (5) • The two study above have documented that SIRS is a simple and rapid predictor of outcome in emergency patients. • The prognostic importance of the SIRS score in hospitalized critically ill patients was prospectively evaluated by Talmor et al. • The findings of the study indicate that SIRS attributable to surgery or surgical stress can be quantitated , and that 24 hrs of ICU resuscitation results in a decline in the SIRS score.
The discussion (6) • The goal of the present study was to investigate whether the severity of SIRS at admission is an accurate predictor of mortality and LOS (length of stay) in trauma patients. • The patients were stratified by age and ISS to eliminate the effect of confounding variable. • The present study documents that admission SIRS score in trauma was a significant independent predictor of both mortality and LOS.
The discussion (7) • The limitation of this study: (a) the data were collected prospectively. (b) some patients were excluded because of incomplete data for calculation of SIRS score may have caused a potential selection bias.
The discussion (8) • The study performed by Mukart and Bhagwanjee, however, showed that SIRS was not a significant predictor of mortality penetrating injury patients. • According to this two studies, we suggest that the SIRS score is a more accurate predictor of mortality in blunt trauma patients (in whom tissue injury is a prime activator of the inflammatory response), compared with penetrating injury patients (in whom hemorrhagic shock is the prime feature).
Conclusion • These study document that early physiologic response to traumatic injury, measured by SIRS criteria, is a valid indicator of outcome in blunt trauma. • We have documented that admission SIRS score in trauma is a rapid and simple tool that may be used as a predictor of outcome and resource utilization and may be helpful in triage decisions and initial patient care in trauma.
