Correlation of American burn association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit

Brian K. Hogan, Steven Wolf, Duane R. Hospenthal, Laurie C. D'Avignon, Kevin K. Chung, Heather C. Yun, Elizabeth A. Mann, Clinton K. Murray

Research output: Contribution to journalReview article

33 Citations (Scopus)

Abstract

Severe burn injury is accompanied by a systemic inflammatory response, making traditional indicators of sepsis both insensitive and nonspecific. To address this, the American Burn Association (ABA) published diagnostic criteria in 2007 to standardize the definition of sepsis in these patients. These criteria include temperature (>39°C or <36°C), progressive tachycardia (>110 beats per minute), progressive tachypnea (>25 breaths per minute not ventilated or minute ventilation >12 L/minute ventilated), thrombocytopenia (<100,000/μl; not applied until 3 days after initial resuscitation), hyperglycemia (untreated plasma glucose >200 mg/dl, >7 units of insulin/hr intravenous drip, or >25% increase in insulin requirements over 24 hours), and feed intolerance >24 hours (abdominal distension, residuals two times the feeding rate, or diarrhea >2500 ml/day). Meeting >3 of these criteria should "trigger" concern for infection. In this initial assessment of the ABA sepsis criteria correlation with infection, the authors evaluated the ABA sepsis criteria's correlation with bacteremia because bacteremia is not associated with inherent issues of diagnosis as occurs with pneumonia or soft tissue infections, and blood cultures are typically obtained due to concern for ongoing infections falling within the definition of "septic." A retrospective electronic records review was performed to evaluate episodes of bacteremia in the United States Army Institute of Research from 2006 through 2007. A total of 196 patients were admitted during the study period who met inclusion criteria. The first positive and negative cultures, if present, from each patient were evaluated. This totaled 101 positive and 181 negative cultures. Temperature, heart rate, insulin resistance, and feed intolerance criteria were significant on univariate analysis. Only heart rate and temperature were found to significantly correlate with bacteremia on multivariate analysis. The receiver operating characteristic curve area for meeting >3 ABA sepsis criteria is 0.638 (95% confidence interval 0.573-0.704; P < .001). Among severe burn patients, the ABA trigger for sepsis did not correlate strongly with bacteremia in this retrospective chart review.

Original languageEnglish (US)
Pages (from-to)371-378
Number of pages8
JournalJournal of Burn Care and Research
Volume33
Issue number3
DOIs
StatePublished - May 1 2012
Externally publishedYes

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Bacteremia
Intensive Care Units
Sepsis
Temperature
Infection
Heart Rate
Insulin
Tachypnea
Soft Tissue Infections
Intravenous Infusions
ROC Curve
Thrombocytopenia
Ventilation
Insulin Resistance
Diarrhea
Pneumonia
Multivariate Analysis
Confidence Intervals
Wounds and Injuries

ASJC Scopus subject areas

  • Surgery
  • Emergency Medicine
  • Rehabilitation

Cite this

Correlation of American burn association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit. / Hogan, Brian K.; Wolf, Steven; Hospenthal, Duane R.; D'Avignon, Laurie C.; Chung, Kevin K.; Yun, Heather C.; Mann, Elizabeth A.; Murray, Clinton K.

In: Journal of Burn Care and Research, Vol. 33, No. 3, 01.05.2012, p. 371-378.

Research output: Contribution to journalReview article

Hogan, Brian K. ; Wolf, Steven ; Hospenthal, Duane R. ; D'Avignon, Laurie C. ; Chung, Kevin K. ; Yun, Heather C. ; Mann, Elizabeth A. ; Murray, Clinton K. / Correlation of American burn association sepsis criteria with the presence of bacteremia in burned patients admitted to the intensive care unit. In: Journal of Burn Care and Research. 2012 ; Vol. 33, No. 3. pp. 371-378.
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