Pediatric Systemic Inflammatory Response Syndrome (PSIRS) Criteria

Pediatric SIRS criteria explained

The following criteria provides specialists with the main directions in which the patient should be evaluated, to confirm or rule out the presence of systemic inflammatory response syndrome in pediatric patients.

The main criterion for SIRS is abnormal temperature:

■ Temperature less than 36°C (96.8°F) or greater than 38.5°C (101.3°F). Obtained either orally, rectally or from catheter probe.

Positive criteria for pediatric SIRS must include abnormal temperature and at least one of the following:

■ Heart rate above normal for average;

■ Unexplained persistent depression for more than 30 minutes;

■ Respiratory rate above normal for age;

■ Need for mechanical ventilation;

■ White blood cell count elevated or depressed;

■ Greater than 10% bands plus other immature forms in WBC.

Abnormal heart rate should not be accounted for by drug, pain stimuli or congenital heart disease. Respiratory rate is likely to be abnormal due to inadequate perfusion or metabolic stress.

These criteria have been in place for sepsis diagnosis until 2016, when there were replaced by qSOFA criteria:

■ Altered Mental Status (GCS <15) – assessed through bedside Glasgow coma scale with the 15 points cut off value between abnormal and normal.

■ Respiratory Rate ≥22 breaths per minute – increased respiratory rate.

■ Systolic Blood Pressure ≤100 mmHg – lowered SBP.

Children with 2 or more of the above criteria require screening for severe sepsis or septic shock.

This is because the original criteria were deemed unspecific and not sensitive enough to be solely relied upon for diagnosis.

When sepsis or SIRS are suspected, the pediatric patient is likely to require further investigations.

Left untreated, SIRS can lead to complications such as organ dysfunction and organ failure, irrespective of cause (infectious or non-infectious).

SIRS diagnosis in children

SIRS is the manifestation of the immune response to inflammation in the case of body exposure to infectious or non infectious agents.

Early recognition of the syndrome is crucial, this condition having mortality rates ranging from 9% to 35%.

Late stage SIRS include multiple organ dysfunction syndrome, peripheral vasodilatation and circulatory collapse.

Pediatric presentation is represented by common infection symptoms, rapid heart beats and laboured breathing. The child may present cool extremities or abnormal fever. In the patient history, there may be evidence of exposure to infectious illnesses or recent immunization.

Currently, diagnosis relies on complete blood count, electrolyte parameters, tests of kidney and liver function but also urinalysis, inflammatory markers and acute phase reactants.

Original source

Goldstein B, Giroir B, Randolph A; International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med. 2005; 6(1):2-8.

Other references

1. Scott HF, Donoghue AJ, Gaieski DF, Marchese RF, Mistry RD. The utility of early lactate testing in undifferentiated pediatric systemic inflammatory response syndrome. Acad Emerg Med. 2012; 19(11):1276-80.

2. Scott HF, Deakyne SJ, Woods JM, Bajaj L. The prevalence and diagnostic utility of systemic inflammatory response syndrome vital signs in a pediatric emergency department. Acad Emerg Med. 2015; 22(4):381-9.

3. Brierley J, Carcillo JA et al. Clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock: 2007 update from the American College of Critical Care Medicine. Crit Care Med. 2009; 37(2):666-88.