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Systemic inflammatory response syndrome criteria in defining severe sepsis

Methodology Score: 4/5                 
Usefulness Score: 3.5/5

Kaukonen KM, Bailey M, Pilcher D, et al.
N Engl J Med. 2015 Apr 23;372(17):1629-38.

This retrospective multicenter study found that the use of SIRS criteria to define severe sepsis within 24 hours of admission to the ICU has poor sensitivity and construct validity, with 1 in 8 patients presenting with <2 criteria and substantial mortality rates; there was also a linear increase in the risk of death with the presence of each additional SIRS criterion, suggesting that the consensus cutoff of 2 may not be valid. The group agreed that the included population may not reflect all-comers with severe sepsis to the ED and that further studies are needed to define the characteristics of patients presenting with SIRS-negative severe sepsis. 
By: Dr. Lauren Lacroix
(Presented May 2015)

Epi lesson:
Characteristics of a Good Article About Prognosis  
As described in the iconic JAMA publication, User’s Guide to the Medical Literature, here are some key questions to ask yourself about an observational study of prognosis.  1) Regarding the validity of the results: a) was the sample of patients representative?, b) were the patients sufficiently homogeneous with respect to prognostic risk?, c) was follow-up sufficiently complete?, and d) were outcome criteria objective and unbiased? 2) In interpreting the results: a) how likely are the outcomes over time? and b) how precise are the estimates of likelihood? 3) How can I apply the results to patient care: a) Were the study patients and their management similar to those in your practice?, b) was the follow-up sufficiently long?, and c) can you use the results in the management of patients in your practice?

By: Dr. Ian Stiell  


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