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

Hernando, Maria Isabel Opper; Witham, Denis; Steinhagen, P.; Angermair, Stefan; Bauer, Wolfgang; Compton, Friederike; Edel, Andreas; Kruse, Jan; Kühnle, York; Lachmann, Gunnar; Marz, Susanne; Müller-Redetzky, Holger; Nee, Jens; Paul, Oliver; Praeger, Damaris; Skurk, Carsten; Stegemann, Miriam; Uhrig, Alexander; Wolf, Stefan; Zimmermann, Elke; Rubarth, Kerstin; Bolanaki, Myrto; Seybold, Joachim; Dewey, Marc; Pohlan, Julian

doi:10.1007/s00330-023-09842-3

Cited by 3 publications

(1 citation statement)

References 25 publications

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“…The guidelines do not provide recommendations for the optimal time window to perform the CT scan. However, the authors suggest a time window of ≥1–6 h (but not exceeding 6 h for maximum benefits) [ 12 ]. Imaging also provides information about the cyst's size and its relationships with the bladder and surrounding tissues [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient

Bertoni,

Pintucci,

Locatelli

et al. 2024

International Journal of Surgery Case Reports

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Section: Discussionmentioning

confidence: 99%

Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient

Bertoni,

Pintucci,

Locatelli

et al. 2024

International Journal of Surgery Case Reports

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Computed tomography in patients with sepsis presenting to the emergency department: exploring its role in light of patient outcomes

Pohlan,

Möckel,

Slagman

et al. 2024

Eur Radiol

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Objectives This study aimed to explore the role of CT in septic patients presenting to the emergency department (ED). Materials and methods We performed a retrospective secondary analysis of 192 septic patients from a prospective observational study, i.e., the “LIFE POC” study. Sepsis was diagnosed in accordance with the Sepsis-3 definition. Clinical and radiological data were collected from the hospital administration and radiological systems. Information on mortality and morbidity was collected. Time-to-CT between CT scan and sepsis diagnosis (ttCTsd) was calculated. Diagnostic accuracy was assessed with the final sepsis source as reference standard. The reference standard was established through the treating team of the patient based on all available clinical, imaging, and microbiological data. Results Sixty-two of 192 patients underwent a CT examination for sepsis focus detection. The final septic source was identified by CT in 69.4% (n = 43). CT detected septic foci with 81.1% sensitivity (95% CI, 68.0–90.6%) and 55.6% specificity (95% CI, 21.2–86.3%). Patients with short versus long ttCTsd did not differ in terms of mortality (16.1%, n = 5 vs 9.7, n = 3; p = 0.449), length of hospital stay (median 16 d, IQR 9 d 12 h–23 d 18 h vs median 13 d, IQR 10 d 00 h–24 d 00 h; p = 0.863), or duration of intensive care (median 3d 12 h, IQR 2 d 6 h–7 d 18 h vs median 5d, IQR 2 d–11 d; p = 0.800). Conclusions Our findings show a high sensitivity of CT in ED patients with sepsis, confirming its relevance in guiding treatment decisions. The low specificity suggests that a negative CT requires further ancillary diagnostic tests for focus detection. The timing of CT did not affect morbidity or mortality outcomes. Clinical relevance statement In patients with sepsis who present to the ED, CT can be used to identify infectious foci on the basis of clinical suspicion, but should not be used as a rule-out test. Scientific evidence for the optimal timing of CT beyond clinical decision-making is currently missing, as potential mortality benefits are clouded by differences in clinical severity at the time of ED presentation. Key Points • In patients with sepsis who present to the ED, CT for focus identification has a high sensitivity and can thereby be valuable for patient management. • As the specificity is considerably lower, a thorough microbiological assessment is important in these cases. • The timing of CT did not affect morbidity and mortality outcomes in this study, which might be due to variability in clinical severity at the time of ED presentation.

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Final-year medical students’ perspective: a survey on the use of computed tomography in sepsis

Pohlan,

Hernando,

Waschinsky

et al. 2023

Insights Imaging

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Objectives To determine the perspective of final-year medical students on the use of computed tomography (CT) in patients with sepsis. Methods A total of 207 questionnaires were distributed to final-year medical students at a large university medical center, and 113 returned questionnaires met the criteria for inclusion in the analysis. Questions referred to sepsis guidelines, CT indications, and the use of contrast agents. Control variables included a level of practical experience as a final-year student (trimester of student’s practical year) and previous radiological experience. Statistical hypothesis tests such as the Mann-Whitney U test and chi-square test were performed. Results The majority of participating students, 85% (n = 91/107), considered a Systemic Organ Failure Assessment (SOFA) score ≥ 2 as a diagnostic criterion for sepsis. The presence of ≥ 2 positive systemic inflammatory response syndrome (SIRS) criteria was considered relevant for diagnosing sepsis by 34% (n = 34/100). Ninety-nine percent (n = 64/65) of the participants who fully agreed with a SOFA score ≥ 2 being relevant for diagnosing sepsis would also use it as an indication for a CT scan. Seventy-six percent (n = 78/103) of the students rated a known severe allergic reaction to contrast agents as an absolute contraindication for its administration. Ninety-five percent (n = 78/82) considered radiation exposure as problematic in CT examinations, especially in repeat CTs. Conclusion Most final-year medical students were familiar with the sepsis criteria. Still, some referred to outdated diagnostic criteria. Participants saw the ability to plan further patient management based on CT as a major benefit. Most participants were aware of radiation as a risk of CT. Critical relevance statement More detailed knowledge of CT in septic patients should be implemented in the medical curriculum. Retraining of medical students could help increase student confidence potentially improving patient care. Key points 1. Whereas the majority of final-year medical students were familiar with sepsis criteria, some referred to outdated diagnostic criteria. 2. Participants saw the ability to plan further patient management based on CT as a major benefit. 3. Most participants were aware of radiation as a risk of CT. Graphical Abstract

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

Cited by 3 publications

References 25 publications

Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient

Diffuse peritonitis secondary to urachal cyst abscess in a postpartum patient

Computed tomography in patients with sepsis presenting to the emergency department: exploring its role in light of patient outcomes

Final-year medical students’ perspective: a survey on the use of computed tomography in sepsis

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