American Association of Plastic Surgeons

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Pressure Sores and SIRS: A UC Davis Quality Improvement Initiative
Abhi Jairam, BA, Ping Song, MD, Nirav Patel, MD, JD, MS, Michael Wong, MD.
UC Davis Medical Center, Sacramento, CA, USA.

PURPOSE:
We aim to propose a modification to the current emergency department triaging algorithm to assist in optimizing the initial treatment plan for patients who present with pressure sores. It is not uncommon for these patients to present acutely ill to the emergency department with a chief concern of a pressure sore, and be referred to plastic and reconstructive surgery (PRS) for urgent wound debridement prior to medical evaluation for other underlying sources of infection.
METHODS:
We performed a retrospective chart review of 36 patients from December 2016 to May 2017 who presented with a chief concern of a pressure sore, met SIRS criteria, and were referred to PRS prior to a complete medical work-up for sepsis.
RESULTS:

Of SIRS patients, 50%, had urosepsis, 33.3%, had sepsis of unknown origin, and 16.7% had other pathologies including osteomyelitis and acute respiratory distress syndrome
CONCLUSION:
Our results demonstrate that half of all pressure sore consultations seen by our PRS service in the span of six months met SIRS criteria and thus had concomitant systemic signs of infection. Furthermore, half of these patients were eventually diagnosed and treated for a urinary tract infection or urosepsis. We propose a new algorithm for triaging pressure sore patients be established that prioritizes a urinalysis for all SIRS positive patients prior to a plastic surgery consult in order to improve patient care.

SIRS vs NON-SIRS Patients
SIRSNON-SIRS
Urosepsis90
Sepsis of unknown origin60
Other30
Total Patients1818


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