Study or Evidence-Based Practice (EBP) Project : Prediction of Sepsis in the Burn ICU Patient
Final rept. 1 Jul 2010-29 Feb 2012
TEXAS UNIV HEALTH SCIENCE CENTER AT HOUSTON
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Purpose The purpose of this study was twofold 1 determine the ability of the SIRS and ABA criteria to predict sepsis in the burn patient and 2 develop a model representing the best combination of clinical predictors associated with sepsis in the same population. Design A retrospective, case-controlled, within-patient comparison of burn patients admitted to a single intensive care unit from January 2005 to September 2010. Methods Blood culture results were paired with clinical condition positive-sick negative-sick, and screening-not sick. Data for predictors were collected for the 72 hours prior to blood culture. Sample Fifty-nine adult, thermally-injured burn subjects were included in the study, representing 177 culture periods. Analysis Significant dichotomized predictor variables were evaluated using logistic regression, Generalized Estimating Equations and ROC AUC analyses to assess model predictive ability. Bootstrapping methods evaluated potential model over-fitting. Findings SIRS criteria were not associated with culture type, with an average of 98 of subjects meeting criteria in the 3 days prior. ABA sepsis criteria were significantly different among culture type only on the day prior p 0.004. The model variables identified included heart rate130, mean blood pressure60 mmHg, base deficit-6 mEqL, temperature36 deg C, use of vasoactive medications, and glucose150 mgdl. The model was significant in predicting positive culture-sick and sepsis state sick, with AUC of 0.775 p 0.001 and 0.714 p .001, respectively comparatively, the ABA criteria AUC was 0.619 p 0.028 and 0.597 p .035, respectively. Implications for Military Nursing ABA criteria performed well, but only for the day prior to positive blood culture results.
- Medicine and Medical Research