Pilot proforma to aid the diagnosis of sepsis in burns patients

Introduction

The aim was to produce and pilot a data collection proforma aiding the diagnosis of sepsis in the burns population. It should be relevant, reliable and lead to reproducible results. We also looked at the data collected to assess the relevance of any findings. In June 2007, the American Burn Association Consensus Conference [1] produced standardized definitions in an attempt to aid clarification of sepsis in those already fulfilling the diagnosis of a systemic inflammatory response syndrome (SIRS). This would allow more consistent diagnosis and accuracy to further trials occurring in this field. The intention is that the proforma will be used by the INTERBURNS research group for a large prospective study.

Methods

This was a retrospective case series. Patients included were those admitted to a regional burns unit with more than 20% burns during December 2007, numbering four. These patients were matched for age, sex, and mechanism of injury. The initial proforma was produced on the basis of the American Burn Association recommendations [1]. Data were collected and reviewed. This revealed potential confounding factors, so the proforma was modified and data recollected. A daily diagnosis of SIRS and sepsis was made from the information collected.

Results

Data were collected at 12 p.m. daily initially. It was noted that haemofiltration and noradrenaline were routinely used. Dressing changes occurred in the morning, leading to increased analgesia, sedation and the release of inflammatory mediators confounding physiological parameters measured. Therefore the proforma was modified and the data recollected at 6 a.m. daily, thus achieving reliable and reproducible data. Despite the small numbers, the data indicated a potential association between an increase in noradrenaline dose of 25% and either instigation of a treatment modality or a diagnosis of SIRS not previously identified, or both.

Conclusion

The proforma is reproducible and gives relevant reliable data for further analysis. The results have highlighted the need for further research to clarify any association between noradrenaline and its place in the diagnosis of sepsis. This proforma and its subsequent utilisation by the INTERBURNS research group should improve our ability to diagnose sepsis and instigate early treatment in this patient population.