It should be pointed out that the original validation of the sepsis syndrome (now called severe sepsis) was in the following landmark paper: Bone RC, et al. Sepsis Syndrome: A Valid Clinical Entity. Critical Care Medicine 17:389-393. The inclusion criterion for temperature was rectal T > 101 degrees F or < 96 degrees F. That would be 38.3 degrees C and 35.5 degrees C. I'm not sure how, exactly, we got to the numbers 38 and 36 in our "standard" criteria, nor how we wandered away from rectal temperatures, unless it was deemed more useful, i.e. more sensitive or more inclusive to allow different methods of obtaining temperature. Interestingly, TM probes and continuous bladder temps were not even available at the time of the original study! Nevertheless, the SSC has demonstrated very much improved survival of patients fitting the more standard criteria, and we should probably be circumspect about tossing them out at this juncture.
SQS >>> Andy Bourgeois <[email protected]> 2/27/2012 11:48 AM >>> SIRS criteria have been defined differently in various studies. The temperature was 38 degrees C in a few early articles: One of the early definitions of sepsis: Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, Schein RM, Sibbald WJ. Chest. 1992 Jun;101(6):1644-55. Review The original Early Goal Directed Therapy article from 2001 Early goal-directed therapy in the treatment of severe sepsis and septic shock. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M; Early Goal-Directed Therapy Collaborative Group. N Engl J Med. 2001 Nov 8;345(19):1368-77. Most of the more recent studies and reviews use 38.3 degrees C: International Sepsis Definitions Conference in 2001 2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, Cohen J, Opal SM, Vincent JL, Ramsay G; SCCM/ESICM/ACCP/ATS/SIS. Crit Care Med. 2003 Apr;31(4):1250-6. Review. In this 2006 review article from some of the original Early Goal Directed Therapy investigators: Severe sepsis and septic shock: review of the literature and emergency department management guidelines. Nguyen HB, Rivers EP, Abrahamian FM, et al. Ann Emerg Med. 2006 Jul;48(1):28-54. Epub 2006 May 2. Review. The Surviving Sepsis Campaign - 2008 Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock: 2008. Dellinger RP, Levy MM, Carlet JM, et al. Crit Care Med. 2008 Jan;36(1):296-327. Erratum in: Crit Care Med. 2008 Apr;36(4):1394-6. I'd recommend 38.3 degrees C to match the more recent definitions so that your sepsis statistics can be easily compared to published studies. Here's an article on comparison of methods of measuring temperature. Bottom line is that IR ear probes are somewhat variable and axillary reads too low. Go with oral, rectal or bladder. Erickson RS, Kirklin SK. Comparison of ear-based, bladder, oral, and axillary methods for core temperature measurement. Crit Care Med. 1993 Oct;21(10):1528-34. PubMed PMID: 8403963. Andy Bourgeois, MD, FAAEM, FACEP Emergency Medicine Simi Valley Hospital On Thu, Feb 23, 2012 at 11:47 AM, Johnston, Roberta <[email protected]> wrote: Hi everyone- Our Sepsis committee would like to know if the temp criteria is 38.3 or 38, and is the method of obtaining the temperature? Thanks in advance, Roberta Roberta Johnston, RN,BS,CMC. Cardiopulmonary Case Manager 700 High St. Williamsport, Pa. 17701 Phone:570-321-2112 ( tel:570-321-2112 ), Fax:570-321-2822 ( tel:570-321-2822 );Cell: 570-560-8993 ( tel:570-560-8993 ) [email protected] Confidentiality Notice: This message and any attachments originate by electronic mail from Susquehanna Health System and their subsidiaries/affiliates (“SHS”). Both this document and any attachments are intended for the sole use of the addressee indicated above and may contain proprietary, privileged and/or confidential information. If you are not the intended recipient of this message, you are hereby notified that any use or disclosure of this information is strictly prohibited. If you received this message in error, or have reason to believe you are not authorized to receive it, please notify the sender by reply email, with a copy to [email protected] and then promptly delete the original and reply messages. Thank you for your cooperation. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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