Sepsis criteria versus clinical diagnosis of sepsis in burn patients: A validation of current sepsis scores
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BACKGROUND: Sepsis remains an ongoing diagnostic challenge in burns, especially with the signs of sepsis being ubiquitously present during the acute period after injury. We aimed to determine the predictive validity of 3 current sepsis criteria in the burn population. The criteria of interest included the American Burn Association sepsis criteria, Mann-Salinas et al predictors of sepsis, and the Sepsis-3 consensus definition. METHODS: Adult patients with an acute burn injury who were diagnosed prospectively with sepsis by the burn team using specific clinical markers were included in this cohort study. Sepsis predictors were collected from patient charts and used to calculate the results of the 3 criteria, then subsequently compared to the clinical diagnosis. RESULTS: Of the 418 patients in the study, which took place from 2000 until 2016, 88 (21%) were septic; the mean age was 50 ± 18 years with a mean percent total body surface area burn of 30% ± 17%. Inhalation injury was present in 50%, median length of stay was 49 (29-71) days, and mortality was 19%. The American Burn Association, Mann-Salinas, and Sepsis-3 criteria were positive in 59%, 28%, and 85% respectively, P < .05. The most reliable predictors included increased oxygen requirements, altered mental status, hypothermia, hyperthermia, tachycardia, and hypotension. CONCLUSION: The Sepsis-3 criteria was the most predictive, followed by the American Burn Association and Mann-Salinas criteria. However, no criterion alone had the accuracy to be a diagnostic standard within this burn population. We recommend sepsis is clinically assessed, diagnosed, and documented prospectively by the burn team, and not by the application of retrospective criteria.
