Systemic inflammatory response syndrome (SIRS) is a bodily response to infections and noninfectious causes. However, the body's inflammatory immune system response can also cause injury to tissues and organs. When an infection goes untreated or improperly treated, it can lead to sepsis, septic shock, organ damage, and death.
When a patient receives medical treatment, they should expect that doctors and healthcare professionals will provider a certain level of care. If the doctors fail to provide a professional standard of care that causes injury, the injury victim may have a claim for medical malpractice.
What is SIRS?
SIRS is a type of medical classification when discussing the body's response to infection and other causes and how it impacts their vital signs. SIRS can be an overly broad classification, and the criteria for shock and sepsis are continually changing. When a patient is suspected of having an infection, certain vital signs and test results may be used to determine if the patient meets SIRS criteria.
- Temperature (fever or hypothermia): Greater than 38°C (100.4°F) or lower than 36°C
- Heart rate: Greater than 90 beats per minute
- Respiratory rate (tachypnea): Greater than> 20 breaths per minute
- White blood cells (leukocytosis, leukopenia, or bandemia): Greater than 12,000/mm³, greater than 4,000/mm³, or greater than 10% bands
If a patient has 2 or more of these criteria, they meet the definition of SIRS. SIRS criteria with infection or suspected infection can lead to sepsis, organ dysfunction, and septic shock.
Since the SIRS criteria was developed, medical groups have recognized limitations to this general classification. Another criteria has been recommended as Sequential (sepsis-related) Organ Failure Assessment (SOFA). Quick SOFA, or qSOFA, is a quick analysis that can identify patients with a greater risk of poor outcome related to sepsis. The score ranges from 0 to 3. A presence of 2 or more qSOFA points can be used to identify sepsis.
- Low Blood Pressure: Systolic blood pressure less than or equal to 100 mmHg
- High respiratory rate (tachypnea): Greater than> 22 breaths per minute
- Altered mediation: Glasgow coma scale (GCS) less than 15.
The Glasgow Coma Scale (GCS) has been used to evaluate an individual's neurological state. This can be used to assess consciousness after a head injury. The GCS evaluates the eye response, verbal response, and motor function, as follows:
- Does not open eyes.
- Eyes open in response to pain stimulus.
- Eyes open in response to speech.
- Eyes open spontaneously.
- No verbal response.
- Makes incomprehensible sounds but no words.
- Makes inappropriate words, speaks words but no sentences.
- Confused or disorientation response.
- Oriented to speech, responds coherently and appropriately to questions.
- No motor response.
- Extension to painful stimulus (decerebrate response).
- Abnormal flexion to stimulus (decorticate response).
- Withdrawal from painful stimulus.
- Localizes to painful stimulus.
- Obeys commands.
If an individual's total GCS score is 14 or lower, then the individual would have one of the qSOFA criteria, and qualifying low blood pressure, and/or high respiratory rate would qualify as qSOFA criteria for sepsis. This can lead to further investigation for organ dysfunction, or have a clinician initiate or escalate therapy, or refer the patient for critical care or increased monitoring.
SIRS and the Signs and Symptoms of Sepsis
Signs that indicate SIRS can be caused by a number of diseases or illnesses, and not just sepsis. Any 2 of the 4 of temperature, heart rate, respiratory rate, or high WBC count can qualify as SIRS criteria. Specifically relating to sepsis, signs and symptoms of sepsis can include:
- Low body temperature
- Increased heart rate
- Increased breathing rate
- Signs of infection
- Blood tests showing signs of infection
Who is at Risk of SIRS/Sepsis?
Individuals with a heightened risk of developing sepsis include those with impaired immune systems. Individuals with the following diseases or illnesses may also have an increased risk of sepsis or septicemia include:
- Urinary tract infections
- Trauma injuries
- Burn injuries
- Solid tumors
- Acquired immune deficiency syndrome (AIDS)
- Individuals on immunosuppressive drugs
Identifying and Treating SIRS
One of the primary purposes of the SIRS criteria is to provide early identification of possible sepsis. Early identification is important in treating serious infections and can give patients a better chance of recovery. In addition to blood tests and vital signs, healthcare professionals should take a proper patient medical history and physical examination, to look for other indicators that the patient may have an infection.
The patient's history can help identify the possible source of the infection, whether it was community acquired, and if the patient is immunocompromised. The patient's history may also include possible exposure to infection through animal exposure, travel, occupational hazards, medications, underlying diseases, alcohol use, or tick bites.
Prognosis After SIRS Qualification
The prognosis in septicemia depends on a number of factors, including early identification and treatment. After identifying possible infection and sepsis, treating a patient may focus on identifying the underlying infection, whether bacterial, viral, or some other source. This can help target treatment. Treatment may also include stabilizing the patient and monitoring the hemodynamic status.
SIRS and Medical Malpractice
A septic inflammatory response may be the result of medical malpractice. Additionally, once a patient shows signs of SIRS, failure to respond to a possible infection may increase the damage caused by septicemia.
Medical negligence that may increase the risk of infection leading to SIRS may include infection during surgery or a hospital acquired infection. Medical negligence that fails to properly diagnose or treat an infection may include:
- Failure to properly treat infection,
- Failure to monitor patients during surgery,
- Failure to monitor pregnant patients,
- Failure to document observations and treatment, or
- Failure to inform patients about the risks of surgery, including infection.
If a doctor or healthcare professional fails to meet their standard of care, which causes injury or harm, the doctor may be liable for damages. Damages in a medical malpractice claim may include:
- Medical bills
- Loss of income
- Pain and suffering
If a family member has died from sepsis and you suspect that the doctors or hospital did not do everything they could to properly treat an infection, you may be able to file a wrongful death lawsuit to get compensation.
Medical Malpractice Help After SIRS
If an injury was caused by medical negligence, talk to an experienced medical malpractice attorney about holding the doctor and hospital accountable for their mistakes. Do not hesitate to contact Gilman & Bedigian today for a free consultation.