Impact of multidetector computed tomography on the diagnosis and treatment of patients with systemic inflammatory response syndrome or sepsis

Schleder, Stephan; Luerken, Lukas; Dendl, Lena Marie; Redel, Andreas; Selgrad, Michael; Renner, Philipp; Stroszczynski, Christian; Schreyer, A. G.

doi:10.1007/s00330-017-4897-6

Cited by 11 publications

(8 citation statements)

References 13 publications

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“…Previously, focus detection with CT was possible in 52.8% of critically ill surgical patients from the ICU [3]. Similarly, repeat CT in patients with sepsis from regular wards or the ICU confirmed a suspected focus in 26% and revealed a new focus in 33% [11]. Both studies used a binary system to describe foci as either positive or negative in CT. We used a more detailed analysis, classifying the presence of septic foci on CT scans as certain, likely, possible, or absent.…”

Section: Discussionmentioning

confidence: 97%

“…Most patients in our study had community-acquired sepsis, although in this population information on previous hospitalizations was not available. Previous studies mainly investigated hospital-acquired sepsis in patients from regular wards or ICUs [3,11]. Remarkably, international guidelines from 2012 used to recommend imaging for focus identification in septic patients [9].…”

Section: Discussionmentioning

confidence: 99%

“…Published data suggest that CT confirms a suspected focus or detects a new focus in the majority of patients with sepsis [3,11]. CT identifies a relevant subset of patients, who require an intervention or surgery [12,13].…”

Section: Introductionmentioning

confidence: 99%

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Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

et al. 2021

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

et al. 2021

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“…The role of full-body CT in septic patients has been studied extensively with respect to focus identification and its impact of patient management ( 14 , 15 ). Previously, our group has shown the accuracy of focus prediction to depend on CT readers' confidence in the diagnosis of sepsis using structured analysis of CT reports ( * blinded for submission).…”

Section: Discussionmentioning

confidence: 99%

“…Whereas there are no specific imaging recommendations for patients with sepsis, computed tomography (CT) is typically used when examining patients under emergency conditions ( 1 ). Body CT has been shown to reliably identify infectious sources in septic patients ( 14 , 15 ). The authors previously conducted a detailed and systematic analysis of the role of CT for focus identification in sepsis in various hospital settings ( 16 – 18 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebrovascular Events in Suspected Sepsis: Retrospective Prevalence Study in Critically Ill Patients Undergoing Full-Body Computed Tomography

et al. 2022

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PurposeThis study aimed at retrospectively evaluating full-body computed tomography (CT) examinations for the prevalence of cerebrovascular events in patients with suspected sepsis treated in the intensive care unit (ICU).MethodsAll full-body CT examinations, i.e., both cranial CT (cCT) and body CT including chest, abdomen and pelvis, for focus search in septic patients over a 12-months period were identified from three ICUs, using full-text search. From this retrospective cohort, we fully analyzed 278 cCT examinations for the occurrence of acute cerebral findings. All acute cerebrovascular events were independently reviewed by two blinded readers. Clinical and laboratory findings were extracted. The data were statistically analyzed using contingency tests.ResultsIn our population of patients with suspected sepsis, 10.8% (n = 30/278) were identified to have major cerebral events, including 7.2% (n = 20/278) major cerebrovascular events and 4.3% (n = 12/278) generalized parenchymal damage. 13.4% (n = 22/163) of patients with a severe coma as compared with non-severe coma, 4.4% (n = 3/68), showed a major cerebral event (p = 0.04). Patients referred from the cardiology/nephrology ICU ward showed major cerebral events in 16.3% (n = 22/135), as compared with 4.9% (n = 3/61) in patients from pulmonary ICU and 6.1% (n = 5/82) major cerebral events with surgical referral (p = 0.02).ConclusionOur study provides further evidence that septic patients may suffer from cerebral events with relevance to their prognosis. Severe coma and the referring ward were associated with acute cerebral conditions. Full-body CT has the advantage of both detecting of septic foci and possibly identifying ischemic or hemorrhagic stroke in this vulnerable patient population.

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Interdisciplinary perspectives on computed tomography in sepsis: survey among medical doctors at a large university medical center

et al. 2023

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Objectives This study aims to describe physicians’ perspectives on the use of computed tomography (CT) in patients with sepsis. Methods In January 2022, physicians of a large European university medical center were surveyed using a web-based questionnaire asking about their views on the role of CT in sepsis. A total of 371 questionnaires met the inclusion criteria and were analyzed using work experience, workplace, and medical specialty of physicians as variables. Chi-square tests were performed. Results Physicians considered the ability to detect an unknown focus as the greatest benefit of CT scans in sepsis (70.9%, n = 263/371). Two clinical criteria — “signs of decreased vigilance” (89.2%, n = 331/371) and “increased catecholamine demand” (84.7%, n = 314/371) — were considered highly relevant for a CT request. Elevated procalcitonin (82.7%, n = 307/371) and lactate levels (83.6%, n = 310/371) were consistently found to be critical laboratory values to request a CT. As long as there is evidence of infection in one organ region, most physicians (42.6%, n = 158/371) would order a CT scan based on clinical assessment. Combined examination of the chest, abdomen, and pelvis was favored (34.8%, n = 129/371) in cases without clinical clues of an infection source. A time window of ≥ 1–6 h was preferred for both CT examinations (53.9%, n = 200/371) and CT-guided interventions (59.3%, n = 220/371) in patients with sepsis. Conclusion Despite much consensus, there are significant differences in attitudes towards the use of CT in septic patients among physicians from different workplaces and medical specialties. Knowledge of these perspectives may improve patient management and interprofessional communication. Key Points Despite interdisciplinary consensus on the use of CT in sepsis, statistically significant differences in the responses are apparent among physicians from different workplaces and medical specialties. The detection of a previously unknown source of infection and the ability to plan interventions and/or surgery based on CT findings are considered key advantages of CT in septic patients. Timing of CT reflects the requirements of specific disciplines.

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Impact of multidetector computed tomography on the diagnosis and treatment of patients with systemic inflammatory response syndrome or sepsis

Cited by 11 publications

References 13 publications

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

Cerebrovascular Events in Suspected Sepsis: Retrospective Prevalence Study in Critically Ill Patients Undergoing Full-Body Computed Tomography

Interdisciplinary perspectives on computed tomography in sepsis: survey among medical doctors at a large university medical center

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