Reliability of the identification of the systemic inflammatory response syndrome in critically ill infants and children

OBJECTIVE:: To assess interobserver reliability of the identification of episodes of the systemic inflammatory response syndrome in critically ill hospitalized infants and children. DESIGN:: Retrospective, cross-sectional study of the application of the 2005 consensus definition of systemic inflammatory response syndrome in infants and children by two independent, trained reviewers using information in the electronic medical record. SETTING:: Eighteen-bed pediatric multidisciplinary medical/surgical pediatric intensive care unit. PATIENTS:: A randomly selected sample of children admitted consecutively to the pediatric intensive care unit between May 1 and September 30, 2009. INTERVENTIONS:: None. MEASUREMENTS AND MAIN RESULTS:: Sixty infants and children were selected from a total of 343 admitted patients. Their median age was 3.9 yrs (interquartile range, 1.5-12.7), 57% were female, and 68% were Caucasian. Nineteen (32%) children were identified by both reviewers as having an episode of systemic inflammatory response syndrome (88% agreement, 95% confidence interval 78-94; κ = 0.75, 95% confidence interval 0.59-0.92). Among these 19 children, agreement between the reviewers for individual systemic inflammatory response syndrome criteria was: temperature (84%, 95% confidence interval 60-97); white blood cell count (89%, 95% confidence interval 67-99); respiratory rate (84%, 95% confidence interval 60-97); and heart rate (68%, 95% confidence interval 33-87). CONCLUSIONS:: Episodes of systemic inflammatory response syndrome in critically ill infants and children can be identified reproducibly using the consensus definition.