Background Use of sepsis-criteria in hospital settings is effective in realizing early recognition, adequate treatment and reduction of sepsis-associated morbidity and mortality. Whether general practitioners (GPs) use these diagnostic criteria is unknown. Objective To gauge the knowledge and use of various diagnostic criteria. To determine which parameters GPs associate with an increased likelihood of sepsis. Methods Two thousand five hundred and sixty GPs were invited and 229 agreed to participate in a survey, reached out to through e-mail and WhatsApp groups. The survey consisted of two parts: the first part aimed to obtain information about the GP, training and knowledge about sepsis recognition, and the second part tested specific knowledge using six realistic cases. Results Two hundred and six questionnaires, representing a response rate of 8.1%, were eligible for analysis. Gut feeling (98.1%) was the most used diagnostic method, while systemic inflammatory response syndrome (37.9%), quick Sequential Organ Failure Assessment (qSOFA) (7.8%) and UK Sepsis Trust criteria (UKSTc) (1.5%) were used by the minority of the GPs. Few of the responding GPs had heard of either the qSOFA (27.7%) or the UKSTc (11.7%). Recognition of sepsis varied greatly between GPs. GPs most strongly associated the individual signs of the qSOFA (mental status, systolic blood pressure, capillary refill time and respiratory rate) with diagnosing sepsis in the test cases. Conclusions GPs mostly use gut feeling to diagnose sepsis and are frequently not familiar with the ‘sepsis-criteria’ used in hospital settings, although clinical reasoning was mostly in line with the qSOFA score. In order to improve sepsis recognition in primary care, GPs should be educated in the use of available screening tools.
Background: Prolonged hospitalization is associated with high costs and mortality, and increases the chance of adverse events. This study aimed to identify predictors of safe, early discharge in patients presenting to the Emergency Department (ED) with an infection. Methods: This prospective observational study was performed in the ED of a tertiary care teaching hospital. Adult non-trauma patients with suspected infection and at least two Systemic Inflammatory Response Syndrome (SIRS) criteria were included. Exclusion criteria were intensive care unit admission and transfer to another hospital. Safe, early discharge was defined as hospital-discharge within 24 hours without disease-related death or readmission to our hospital during the first 7 days. A prediction model for safe, early discharge was created using a multivariate logistic regression analysis and validated with k-fold cross-validation. Results: 1381 patients were included, of whom 354 (25.6%) met the safe, early discharge criteria. Parameters associated with safe, early discharge were younger age, absence of co-morbidities, living independently, yellow or green triage urgency, absence of ambulance transport, absence of general practitioner referral, normal clinical impression, (q)SOFA, PIRO, MEDS, NEWS and SIRS scores, absence of abnormal vital sign measurements and absence of kidney and respiratory failure. A prediction model for safe, early discharge was developed with an area under the curve (AUC) of 0.824. Internal validation generated a minimal drop in performance, indicating a good fit. Conclusion: By identifying predictors of clinical improvement and combining several readily available parameters in the ED setting, a model for safe, early discharge with good prognostic performance was created.
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