Systemic inflammatory response syndrome score at admission independently predicts infection in blunt trauma patients

Background: Systemic inflammatory response syndrome (SIRS) score has been d emonstrated to be an accurate predictor of outcome in critical surgical ill ness. To our knowledge, there is a paucity of data using SIPS score as a to ol to predict posttraumatic infection. Our goal was to determine whether th e severity of SIRS score at admission is an accurate predictor of infection in trauma patients. Methods: Prospective data were collected on 4,887 blunt trauma patients adm itted to a primary adult resource center designated trauma center over an 1 8-month period. Patients were stratified by age and Injury Severity Score ( ISS), SIPS score was calculated at admission. SIRS was defined as an SIPS s core greater than or equal to 2. Each patient was screened for infection by an infectious disease specialist. Those at high risk for infection were th en monitored daily throughout their hospitalization. Centers for Disease Co ntrol and Prevention guidelines were used to diagnose infection. Results: Of the 4,887 patients, 1,850 (38%) were admitted > 24 hours and ev aluated for subsequent infection (mean ISS, 16 +/- 9; mean age, 43 +/- 19, SD). Thirty-one percent (577) of the patients acquired an infection. The me an hospital length of stay (20.2 days vs. 6.5 days) and mortality (7.8% vs. 2.7%) were significantly greater in the infected group (p < 0.001). Of the four SIPS variables (temperature, heart rate, white blood cell count, and respiratory rate), hypothermia and leukocytosis mere the most significant p redictors of infection (p < 0.001) when adjusted for age and ISS, SIPS scor es of <greater than or equal to> 2 were increasingly predictive of infectio n when analyzed by multiple logistic regression analysis. Conclusion: An admission SIPS score of greater than or equal to 2 is a sign ificant independent predictor of infection and outcome in blunt trauma. Dai ly SIPS scores may be a meaningful method of assessing postinjury risk of i nfection, and may initiate earlier diagnostic intervention for determinatio n of infection.