Simply put, the arbitrary cutoff of two or more features to declare SIRS positive is not supported by the evidence. These authors summarize their findings in perfect harsh clarity: “Our findings challenge the sensitivity, face validity, and construct validity of the rule regarding two or more SIRS criteria in diagnosing or defining severe sepsis.”

Thus, neither does SIRS equate with sepsis, nor do all patients with severe sepsis manifest SIRS. Yet our practice is governed by tools subjecting us to cognitive bludgeoning based on these criteria. This is a sad convergence of distracting, ineffective, and inefficient medicine, and we ought collectively to resist such efforts. The consequences of such “quality”-driven initiatives are clear: distractions, overdiagnosis, and waste. Early detection of sepsis absolutely has value, but we should demand we are provided with better tools.

Complete the CME activity.

References

1. Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101:1644-1655.
2. Amland RC, Hahn-Cover KE. Clinical decision support for early recognition of sepsis. Am J Med Qual. 2014 Nov 10. [ePub ahead of print]
3. Horeczko T, Green JP, Panacek EA. Epidemiology of the systemic inflammatory response syndrome (SIRS) in the emergency department. West J Emerg Med. 2014;15:329-336.
4. Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. NEJM. 2015;372:1629-1638.