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

Background: Systemic inflammatory response syndrome (SIRS) score has been demonstrated to be an accurate predictor of outcome in critical surgical illness. To our knowledge, there is a paucity of data using SIPS score as a tool to predict posttraumatic infection. Our goal was to determine whether the 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 admitted to a primary adult resource center designated trauma center over an 18-month period. Patients were stratified by age and Injury Severity Score (ISS), SIPS score was calculated at admission. SIRS was defined as an SIPS score greater than or equal to 2. Each patient was screened for infection by an infectious disease specialist. Those at high risk for infection were then monitored daily throughout their hospitalization. Centers for Disease Control and Prevention guidelines were used to diagnose infection. Results: Of the 4,887 patients, 1,850 (38%) were admitted > 24 hours and evaluated for subsequent infection (mean ISS, 16 +/- 9; mean age, 43 +/- 19, SD). Thirty-one percent (577) of the patients acquired an infection. The mean 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 predictors of infection (p < 0.001) when adjusted for age and ISS, SIPS scores of 2 were increasingly predictive of infection when analyzed by multiple logistic regression analysis. Conclusion: An admission SIPS score of greater than or equal to 2 is a significant independent predictor of infection and outcome in blunt trauma. Daily SIPS scores may be a meaningful method of assessing postinjury risk of infection, and may initiate earlier diagnostic intervention for determination of infection.