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Overview :
Elebute and Stoner proposed a simple system for grading the
severity of sepsis based on the clinical and laboratory findings. This system
indicates the severity of sepsis in the individual patient and allows comparison
of different treatment options and of outcomes from different treatment
centers.
4 attributes of sepsis:
(1) local effects of tissue infection
(2) pyrexia
(3) secondary effects of sepsis
(4) laboratory findings
Local Effects of
Tissue Infection
|
Attribute |
Finding |
Score |
|
wound infection with purulent discharge and/or
enterocutaneous fistula |
requiring only light dressing changed not more than
once daily |
2 |
|
|
requiring to be dressed with a pack, dressing needing
to be changed more than once a day, requiring application of a bag and/or
requiring suction |
4 |
|
|
none |
0 |
|
peritonitis |
localized |
2 |
|
|
generalized |
6 |
|
|
none |
0 |
|
chest infection |
clinical or radiological signs of chest infection
without productive cough |
2 |
|
|
clinical or radiological signs of chest infection with
a cough producing purulent sputum |
4 |
|
|
full clinical manifestations of lobar or
bronchopneumonia |
6 |
|
|
none |
0 |
|
deep seated infection |
subphrenic abscess, pelvic abscess, empyema thoracis,
acute or chronic osteomyelitis |
6 |
|
|
none |
0 |
score local effects =
= (points for wound infection) + (points for peritonitis) +
(points for chest infection) + (points for deep seated infection)
minimum score: 0
maximum score: 22
NOTE: The scoring of local effects is a little unclear. A
second option is that only the maximum score from the table is used. This would
give a maximum score of 6. An argument for this interpretation is that the data
in Table V does not exceed a total sepsis score of 23.
Pyrexia (Oral
Temperature)
|
Attribute |
Finding |
Score |
|
maximum daily temperature |
> 39 °C |
3 |
|
|
38.5 - 39° C |
2 |
|
|
37.5 - 38.4 °C |
1 |
|
|
36 - 37.4 °C |
0 |
|
|
< 36° C |
3 |
|
minimum daily temperature |
> 37.5° C |
1 |
|
|
<= 37.5 |
0 |
|
number of temperature peaks > 38.4° C in 1
day |
>= 2 |
1 |
|
|
0 or 1 |
0 |
|
number of rigors that occur in a day |
>= 1 |
1 |
|
|
0 |
0 |
score for pyrexia =
= (points for maximum daily temperature) + (points for
minimum daily temperature) + (points for number of temperature peaks) + (points
for rigors)
minimum score: 0
maximum score: 6
Secondary Effects of
Sepsis
|
Attribute |
Finding |
Score |
|
obvious jaundice in the absence of established
hepatobiliary disease |
present |
2 |
|
|
absent |
0 |
|
metabolic acidosis |
compensated |
1 |
|
|
uncompensated |
2 |
|
|
absent |
0 |
|
renal failure |
present |
3 |
|
|
absent |
0 |
|
gross disturbance of mental orientation/ level of
consciousness |
delirium, coma) and/or other focal neurological
manifestations of pyemia or septicemia, having excluded other
causes |
3 |
|
|
absent |
0 |
|
bleeding diathesis |
associated with disseminated intravascular coagulation
(DIC) |
3 |
|
|
not associated with DIC |
0 |
score for secondary effects of sepsis =
= (points for jaundice) + (points for acidosis) + (points for
renal failure) + (points for mental disturbance) + (points for bleeding
diathesis)
minimum score: 0
maximum score: 13
Scoring of Laboratory
Data
|
Attribute |
Finding |
Score |
|
blood culture |
negative |
0 |
|
|
single positive culture |
1 |
|
|
two or more positive cultures separated by 24
hours |
3 |
|
|
single positive culture plus history of invasive
procedure |
3 |
|
|
single positive culture plus cardiac murmur and/or
tender enlarged spleen |
3 |
|
leukocyte count |
> 30,000 per µL |
2 |
|
|
12,000 - 30,000 per µL |
1 |
|
|
2,500 - 12,000 per µL |
0 |
|
|
< 2,500 per µL |
3 |
|
hemoglobin level in absence of obvious bleeding |
> 10 g/dL |
0 |
|
|
7 - 10 g/dL |
1 |
|
|
< 7 g/dL |
2 |
|
platelet count |
> 150,000 per µL |
0 |
|
|
100,000 - 150,000 per µL |
1 |
|
|
< 100,000 per µL |
2 |
|
plasma albumin |
> 3.5 g/dL |
0 |
|
|
3.1 - 3.5 g/dL |
1 |
|
|
2.5 - 3.0 g/dL |
2 |
|
|
< 2.5 g/dL |
3 |
|
plasma total bilirubin level in the absence of
clinically obvious jaundice |
<= 25 µmol/L (1.46 mg/dL) |
0 |
|
|
> 25 µmol/L |
1 |
score for laboratory data =
= (points for blood culture) + (points for leukocyte count) +
(points for hemoglobin) + (points for platelet count) + (points for albumin) +
(points for total bilirubin)
minimum score: 0
maximum score: 14
Aggregate Score
aggregate score =
= (score for local effects) + (score for pyrexia) + (score
for secondary effects) + (score for laboratory data)
Interpretation:
• minimum
score: 0
• maximum
score: 55
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