{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T07:49:28Z","timestamp":1768031368936,"version":"3.49.0"},"reference-count":17,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2023,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the positive predictive value (PPV) of a sepsis\u2010screening protocol in patients with cervical spinal cord injury (SCI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design\/Method<\/jats:title><jats:p>Retrospective review of all patients with cervical SCI who screened positive for two or more systemic inflammatory response syndrome (SIRS) criteria while hospitalized in acute care or inpatient rehabilitation units over a 3.5\u2010year period. Sepsis was defined by the occurrence of (1) any culture order followed by an intravenous (IV) antibiotic within 72\u2009hours or (2) an IV antimicrobial followed by a culture order within 24\u2009hours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 134 patients screened positive for two or more SIRS criteria. Of these, 36 patients (26.9%) were diagnosed with sepsis. Factors associated with a true\u2010positive SIRS screen on multivariable analysis included American Spinal Injury Association Impairment Scale (AIS) grade A\u2010C (vs. D; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). The PPV of the screen was 38% in patients with AIS A\u2010C and 9% in patients with AIS D. Altered mental status (AMS) was strongly associated with a diagnosis of sepsis; 16 of 18 (88.9%) of those with AMS had sepsis (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001). Age, sex, and neurologic level of injury were not associated with true\u2010positive screening. For patients with new SCI, the first true\u2010positive screen occurred a median of 31\u2009days post\u2010injury. The most common SIRS criteria combinations in patients with true\u2010positive screens were elevated heart rate and either abnormal white blood cell count (43% of true positives) or abnormal temperature (26% of true positives). Abnormally low body temperature (&lt;36\u00b0C) contributed to false\u2010positive screening for 10 of 38 (26%) AIS D patients who screened positive.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Sepsis screening using SIRS criteria in hospitalized patients with tetraplegia has a PPV of 26.9%; it is significantly higher in patients with AIS A\u2010C versus D injuries. AMS, when combined with a positive SIRS screening, is strongly associated with sepsis.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pmrj.12919","type":"journal-article","created":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T20:38:57Z","timestamp":1666384737000},"page":"976-981","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Positive predictive value of a <scp>sepsis\u2010screening<\/scp> protocol for patients with tetraplegia"],"prefix":"10.1002","volume":"15","author":[{"given":"Daniel B.","family":"Goldish","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erica L.","family":"Bechtel","sequence":"additional","affiliation":[{"name":"MultiCare Physical Medicine and Rehabilitation\u2010 Puyallup  Puyallup Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret W.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David J.","family":"Carlbom","sequence":"additional","affiliation":[{"name":"Department of Medicine, Pulmonary Critical Care &amp; Sleep Medicine University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen P.","family":"Burns","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington  Seattle Washington USA"},{"name":"Spinal Cord Injury Service VA Puget Sound Health Care System  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7043-9893","authenticated-orcid":false,"given":"Deborah A.","family":"Crane","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine University of Washington  Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"e_1_2_7_2_1","unstructured":"Respiratory Management Following Spinal Cord Injury: A Clinical Practice Guideline for Health\u2010Care Professionals.Consortium for Spinal Cord Medicine Clinical Practice Guidelines2005:21."},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.08.003"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-2727.129089"},{"key":"e_1_2_7_5_1","volume-title":"Facts and figures at a glance","author":"National Spinal Cord Injury Statistical Center","year":"2019"},{"key":"e_1_2_7_6_1","first-page":"80","volume-title":"Spinal cord medicine","author":"Devivo MJ","year":"2011"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/aws267"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2018.6245"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010307"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201604-0854OC"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0288"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1179\/204577211X13207446293695"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31827e83af"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2004.03.016"},{"key":"e_1_2_7_15_1","volume-title":"Facts and figures at a glance","author":"National Spinal Cord Injury Statistical Center","year":"2000"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-003-1874-0"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2019.01.012"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-019-0330-0"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12919","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmrj.12919","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.12919","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,25]],"date-time":"2023-08-25T12:30:08Z","timestamp":1692966608000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.12919"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,20]]},"references-count":17,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2023,8]]}},"alternative-id":["10.1002\/pmrj.12919"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.12919","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,20]]},"assertion":[{"value":"2021-12-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-10-01","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}