784 Automated SIRS Alert Systems Are Ineffective at Predicting Sepsis in Burn Patients

Introduction Burn injury patients represent a population at particularly high risk for sepsis and sepsis mortality due to the severe immunological insult. Because of the unique nature of burn injury, this population has largely been excluded from studies developing protocols for identification and treatment of sepsis. In our institution, the protocolized approach to sepsis starts with an alert if two SIRS criteria are met, regardless of the patient’s diagnosis. We examined whether the SIRS alert was an effective way to identify and treat sepsis in burn patients. Methods Patients admitted to the burn surgery service at an academic regional burn center were identified by querying the “SIRS alert” dashboard from the hospital’s quality and safety department. The dashboard is a record of every patient whose clinical status triggered a SIRS alert during hospital admission, and whether a screening order set was opened. The SIRS alert and order set usage data were analyzed directly from the dashboard. Each patient’s chart was then reviewed to decide whether there was clinical suspicion of sepsis at the time an order set was released. We determined that there was clinical suspicion of sepsis if antibiotics were initiated or escalated within 6 hours of a SIRS screening order set being opened. Results From January 1, 2019 until September 14, 2019 there were 225 patients admitted to the burn surgery service at an academic regional burn center. 70 patients, specifically receiving treatment in the burn ICU, met the criteria to trigger a SIRS alert at least once in that time. Across those 70 patients, a total of 1381 SIRS alerts were acknowledged by the nursing staff. Due to a lack of clinical suspicion for sepsis, the SIRS screening order set was opened 8.5% of the time an alert was acknowledged. Only two times in the 1381 alerts was an order set opened and then followed by the initiation or escalation of antibiotics within 6 hours. Conclusions SIRS criteria appear to be ineffective at helping clinicians to identify and treat sepsis in the burn patient population. This is consistent with the fact that burn patients are in a virtually constant state of inflammation, making SIRS alerts futile at picking up subtle changes that could indicate early sepsis. Applicability of Research to Practice Hospitals should abandon the use of the standard SIRS criteria as a starting point for sepsis protocols when treating burn patients. There does not yet exist a validated criteria set to replace the standard SIRS criteria. In the meantime, the Burn Sepsis Consensus Conference definitions could be used as a guideline to modify the criteria, and future research should continue seeking to identify early predictors of sepsis in the burn population.