13 Utilization of a Burn Sepsis Algorithm: A Five-Year Analysis

Abstract

Abstract Introduction After the first 24 hours, the major cause of death in burn patients is multiple organ dysfunction/failure syndrome. It is preceded by an infection in 83% of burn patients, with reported septic mortality up to 65%. Since the early recognition and treatment of infection has been shown to decrease mortality from sepsis, we implemented a multidisciplinary algorithm designed to rapidly identify septic adult burn patients. Methods Adult (≥18 y) admissions between 7/1/2014 – 6/30/2019 were identified from our registry, and all initial sepsis screens were evaluated in the EMR. Patients were screened clinically at least twice daily and were considered a “positive” screen if MAP < 65 mmHg (SBP< 90 mmHg) or if 2 of the 3 occurred: Temp >102.2F; HR >120; RR >28 (or RR >10% of ventilator set rate if set rate is >24 bpm). A positive screen prompted lab work to include CBC, BMP, procalcitonin (PCT), and lactic acid (LA), per protocol. If PCT >3.0 ng/ml or LA >2.0 mmol/L, or both thrombocytopenia and hyperglycemia were present, a “Burn Code Sepsis” was initiated and included cultures, a CXR, and empiric antibiotics. A patient was then formally considered “septic” (i.e. infected) if the cultures were positive or the CXR demonstrated an infectious process. Results There were 1,523 admissions during the 5-year period, and 228 initial positive screens. Of the 228 patients with positive screens, 159 (70%) were infected. There was a significant difference in PCT level between patients with and without infections, while no difference was noted for LA, WBC, platelets, temperature, glucose, age, %TBSA burned, or time to triggering a positive screen between the groups (Table). Defining PCT ≥3.0 ng/mL as being positive for sepsis demonstrated a 76% PPV and a 36% NPV for PCT alone. Our initial sepsis screening algorithm had a sensitivity of 64.8% and a specificity of 40.6% over the five-year period. Conclusions Recognition of sepsis remains difficult in burn patients. PCT and the use of a sepsis screening algorithm may have a role in the early detection of sepsis. Further research is warranted.