My week with SIRS

I’ve been down for several days this week with influenza A, which is not shocking since this year’s vaccine (yes, I did receive it) has a whopping 51% effectiveness against the predominant circulating strain. You’ll have to find our prior posts on the horrible influenza vaccine on your own, myalgias prevent me from adding more links. 

Early into illness, I had a vivid dream in which I was being admitted to a hospital. A doctor who looked exactly like the Phillie Phanatic told me I met criteria for SIRS/sepsis, and started administering vancomycin and piperacillin-tazobactam by direct injection into my kidneys. 

But the only thing more boring than stories about people's self-limited viral infections are stories about their dreams, so I’ll stop now and retire quickly to my sofa (this, of course, is a really bad sepsis pun about the new qSOFA score). For while I did meet SIRS criteria, I never met qSOFA criteria (RR >= 22/min, altered mentation, or SBP <= 100 mm Hg), demonstrating with an N of 1 that qSOFA is more specific for identifying those likely to suffer "poor outcomes typical of sepsis".

Eli already linked to the Third International Consensus Definitions for sepsis, which are well worth a read. There is also an excellent piece in Slate about sepsis, by Dr. Jeremy Faust (an Emergency Medicine resident at Mt. Sinai in NYC), that accessibly covers the new definitions and the unintended adverse consequences of the CMS sepsis measure, including those that impact antibiotic stewardship. Finally, ECCMID is underway and I’ve already read tweets about a terrific session on sepsis there today—I’m assuming the content will be available at this link once the session is uploaded.


  1. Dan, what are your thoughts on qSOFA's applicability to nursing home patients? At first glance, I see a problem with using GCS. The GCS is rarely (if ever) used in this setting. Would it need to be adapted in some way that would make it meaningful to use in this population? Would a measure for delirium be more appropriate?

  2. Hi Kirk, Great point--looks like the qSOFA was derived from acute care hospital data, so may not generalize to long term care as you point out. A comparably simple score that predicts poor outcome and could be used to drive early intervention/transfer for long term care residents would be valuable. Dan


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