PURPOSE: The criteria for the diagnosis of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis (SS) and multiorgan dysfunction syndrome (MODS) have been well established. The early diagnosis of sepsis and early intervention have been shown to have beneficial effects on the outcomes of septic patients. However, using the sepsis criteria in a clinical setting is very subjective, despite rigid quantitative criteria. We evaluated the intraobserver variability for diagnostic consistencies and the temporal relationship between their subsequent diagnoses of the sepsis continuum.
METHODS: 32 patients receiving care in a medical intensive care unit were evaluated retrospectively via chart review by two physicians to determine the time and date that the patients met criteria for SIRS, sepsis, SS, and MODS within a defined time period. Variations in diagnoses and time of diagnoses were compared between the physicians using MS Excel.
RESULTS: For the diagnosis of SIRS, observers were 100% congruent and made the diagnosis within 5.5 +/- 10.1(mean +/- SD) hours of each other. For sepsis, observers were congruent in 93.7% of cases, making the diagnosis within 1.9 +/−6.3 hours of each other. For SS, observers were congruent in 93.7% of cases, making the diagnosis within 4.3 +/- 12.8 hours of each other. For MODS, observers were congruent 96.9% of the time, making the diagnosis within 0.2 +/- 0.8 hours of each other.
CONCLUSION: Observers had the least congruency in their diagnoses when defining sepsis and SS, whereas SIRS and MODS had more congruency between observers. The observers were able to diagnose MODS and sepsis with the least amount of time variability whereas the diagnosis of SIRS and SS were more variable.
CLINICAL IMPLICATIONS: Early detection of sepsis is pertinent in improving outcomes in critically ill patients. Our study shows that the sepsis continuum allows for great variability and subjectivity in these diagnoses. Future studies might increase the number of observers to more accurately define the sepsis continuum and take into account experience level of the observers.
DISCLOSURE: Lauren Pitkow, No Financial Disclosure Information; No Product/Research Disclosure Information