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Systemic Inflammatory Response Syndrome Score at Admission Independently Predicts Mortality and Length of Stay in Trauma Patients

Napolitano, Lena M. MD; Ferrer, Thomas MD; McCarter, Robert J. Jr. ScD, and; Scalea, Thomas M. MD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2000 - Volume 49 - Issue 4 - p 647-653
Annual Meeting Articles

Background Recent studies have documented that the systemic inflammatory response syndrome (SIRS) score is a useful predictor of outcome in critical surgical illness. The duration and severity of SIRS are associated with posttrauma multiple organ dysfunction and mortality. We sought to determine whether the severity of SIRS at admission is an accurate predictor of mortality and length of stay (LOS) in trauma patients.

Methods Prospective data of 4,887 trauma admissions to a Level I trauma center over a 18-month period (January 1997 to July 1998) were analyzed. Patients were stratified by age and Injury Severity Score (ISS), and a SIRS severity score (1 to 4) was calculated at admission (1 point for each component present: fever or hypothermia, tachypnea, tachycardia, and leukocytosis). The SIRS score was evaluated as an independent predictor of mortality and LOS by χ2 and multivariate logistic regression.

Results Trauma patients (n = 4,887, 83% blunt injuries, 72% male) had the following characteristics: 73.1% were age 18 to 45 years, 17.5% were age 46 to 65 years, and 9.4% were age ≥66 years; 77.7% had ISS less than 15, 18.8% had ISS 16 to 29, and 3.5% had ISS greater than 29. Analysis of variance adjusting for age and ISS determined that SIRS score of 2 was a significant predictor of LOS. Furthermore, the relative risk of death increased significantly with SIRS score of 2 when age and ISS were held constant.

Conclusion Logistic regression analysis confirmed that a SIRS score of 2 was a significant independent predictor of increased mortality and LOS in trauma patients. These data suggest that admission SIRS scoring in trauma patients is a simple tool that may be used as a predictor of outcome and resource utilization.

From the R. Adams Cowley Shock Trauma Center and Department of Surgery (L.M.N., T.F., T.M.S.), and the School of Epidemiology (R.J.M.), University of Maryland School of Medicine, Baltimore, Maryland.

Submitted for publication February 10, 2000.

Accepted for publication August 11, 2000.

Presented at the 13th Annual Meeting of the Eastern Association for the Surgery of Trauma, January 12–15, 2000, Sanibel, Florida.

Address for reprints: Lena M. Napolitano, MD, Department of Surgery, University of Maryland Medical Center, Room N4E27, 22 South Greene Street, Baltimore, MD 21201; email:

© 2000 Lippincott Williams & Wilkins, Inc.