Diagnostic criteria and treatment protocol for post-burn sepsis

The diagnostic criteria of sepsis have been in accordance with those of the systemic inflammatory response syndrome for decades [1]. Scholars find them inadequate, however, especially for burn patients. After discussion by burn experts in China [2], the following diagnostic criteria and therapy guidelines for sepsis are suggested.

Diagnostic criteria

Preliminary diagnosis of post-burn sepsis can be made if six out of the first 11 criteria below are met. This preliminary diagnosis can be confirmed if any one aspect described in the last criterion is met.

The diagnostic criteria are: (1) mental excitement, hallucinations, disorientation or depression; (2) abdominal distension, diminished bowel sound; (3) rapidly deteriorated burn wounds, exhibited as wet, dark and/or deepened wounds with necrotic spots, and so forth; (4) core temperature >39.0°C or <36.5°C; (5) increased heart rate - adults >130 times/minute, children of all ages >2 standard deviations of normal value; (6) increased respiratory rate - adults >28 times/minute (without mechanical ventilation), children of all ages >2 standard deviations of normal value; (7) thrombocytopenia - adults <50 × 10⁹/l, children of all ages <2 standard deviations of normal value; (8) peripheral white blood cell count - adults >15 × 10⁹/l or <5 × 10⁹/l, in which neutrophil percentage >80% or immature granulocytes >10%, children of all ages >2 or <2 standard deviations of normal value; (9) blood procalcitonin >0.5 μg/l; (10) blood sodium levels >155 mmol/l; (11) blood glucose >14 mmol/l (no history of diabetes); and (12) positive blood culture or positive response to antibiotic therapy.

Treatment guidelines

Recommended guidelines include infectious source control, rational use of antibiotics, continuous blood purification, application of glucocorticoids, immunomodulation, symptomatic and supportive treatment, and prevention of hospital-acquired infection.