1991

Historic septic conference in Northbrook, IL proposes SIRS criteria as objective basis for sepsis diagnosis: To promote early diagnosis of sepsis before septic shock set in, Canadian researcher John Marshall proposed “systematic inflammatory response syndrome” (SIRS) to identify septic response to infection. Definition Committee proposed criteria that remain in use today. The four criteria for diagnosing SIRS were: (1) body temperature; (2) heart rate greater than 90 beats per minute; (3) elevated respiratory rate; and (4) white cell count greater than 12,000 or lower than 4,000. If two of the four criteria were met, patient was considered “SIRS positive,” resulting in a new definition of sepsis (“Sepsis 1”) as infection plus SIRS. Despite concern that SIRS criteria risked overdiagnosis, sepsis experts believed that “waiting for objective signs of shock or a toxic-appearing patient – was unacceptable. A system was needed to identify the syndrome much earlier” (Shahinpoor, 187-191). The concern of critics was borne out in 2001, when the Sepsis 2 task force found SIRS diagnostic usefulness limited by its nonspecificity, since patients could meet SIRS criteria without being septic. A 2003 survey found that only 20% of intensivists and 5% of all other physicians used SIRS when diagnosing sepsis (257-258).