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Background: Characterize the clinical and prognostic importance of the systemic inflammatory response syndrome (SIRS) in an emergency department (ED). Methods: Prospective observational study with follow-up until hospital discharge. Triage in an ED of an urban tertiary health care institution. All consenting adult (>18 years of age) patients presenting to the ED over a 2 week period. SIRS criteria were assessed in all participants. Admission rate, length of stay, and hospital charges. Results: During the study period, there were 1148 distinct ED patient visits, of which 991 patients participated. Of these, 247 (24.9%) met criteria for SIRS defined as the presence of >2 SIRS criteria. Patients with SIRS had higher admission rates (41.3% vs. 13.6%, p<0.001), longer lengths of ED stay (8.0 ± 5.9 vs. 6.0 ± 4.6 h, p<0.001), and higher ED charges ($463 ± 30 vs. $283 ± 11, p < 0.001). If admitted, patients with SIRS in the ED had longer inpatient stays (8.7 ± 12.0 vs. 4.5 ± 4.6 days, p < 0.004), increased service costs ($30,305 ± $3000 vs. $11,362 ± $1130, p < 0.002), and trended towards increased procedural charges ($5326 ± $527 vs. $3204 ± $320, p<0.067). Additional SIRS criteria present at entry led to higher admission rates and longer ED and inpatient stays. The sensitivity, specificity, positive predictive value, and negative predictive value of admission to the hospital for those meeting criteria for SIRS were 50.3%, 81.6%, 41.3%, and 86.4%, respectively. Of patients meeting criteria for SIRS, 59% were discharged home from the ED. Conclusion: The presentation of patients with SIRS in the ED is common. Patients presenting to the ED meeting criteria for SIRS utilize greater health care resources than their non-SIRS counterparts, but SIRS is a poor predictor of the need for hospitalization. *Correspondence to: Douglas S Ander, Department of Emergency Medicine, 49 Jesse Hill Jr Doctor Atlanta, GA 30303, USA, E-mail: dander@emory.edu Received: November 12, 2018; Accepted: November 20, 2018; Published: November 23, 2018 Abbreviations: ACCP: American College of Chest Physicians; CI: Confidence Interval; ED: Emergency Department; ICU: Intensive Care Unit; LOS: Length of Stay; NINT: Noninfectious and Nontraumatic; SCCM: Society of Critical Care Medicine; SD: Standard Deviation; SIRS: Systemic Inflammatory Response Syndrome

Systemic Inflammatory Response Syndrome (SIRS) in the Emergency Department: An Original Investigation – A Look Back in Time