Recognition of sepsis in primary care: a survey among GPs.

Feike J Loots,Rogier M Hopstaken,Marleen Smits,Roeland Arpots,Rick Van Den Berg,Paul Giesen

doi:10.3399/bjgpopen17x100965

Abstract

BackgroundEarly recognition and treatment of sepsis are important to reduce morbidity and mortality. Screening tools using vital signs are effective in emergency departments. It is not known how the decision to refer a patient to the hospital with a possible serious infection is made in primary care.AimTo gain insight into the clinical decision-making process of GPs in patients with possible sepsis infections.Design & settingSurvey among a random sample of 800 GPs in the Netherlands.MethodQuantitative questionnaire using Likert scales.ResultsOne hundred and sixty (20.3%) of questionnaires were eligible for analysis. Based on self-reported cases of possible serious infections, the factors most often indicated as important for the decision to refer patients to the hospital were: general appearance (94.1%), gut feeling (92.1%), history (92.0%), and physical examination (89.3%). Temperature (88.7%), heart rate (88.7%), and blood pressure (82.1%), were the most frequently measured vital signs. In general, GPs more likely referred patients in case of: altered mental status (98.7%), systolic blood pressure <100 mmHg (93.7%), unable to stand (89.3%), insufficient effect of previous antibiotic treatment (87.4%), and respiratory rate ≥22/minute (86.1%).ConclusionThe GPs' assessment of patients with possible serious infection is a complex process, in which besides checking vital signs, many other aspects of the consultation guide the decision to refer a patient to the hospital. To improve care for patients with sepsis, the diagnostic and prognostic value of assessing the vital signs and symptoms, GPs' gut feeling, and additional diagnostic tests, should be prospectively studied in the primary care setting.

Highlights

Reducing morbidity and mortality from sepsis is a major healthcare challenge.[1]
This study showed the highest odds ratios for advanced age, immunosuppressive medication, alcohol-related conditions, and psychotic disorders
The results of this study indicate the quick Sequential Organ Failure Assessment (qSOFA) score is more in line with the clinical reasoning of GPs than the systemic inflammatory response syndrome (SIRS) criteria

Summary

Introduction

Reducing morbidity and mortality from sepsis is a major healthcare challenge.[1]. Millions of people are suffering from sepsis each year worldwide,[2] and one in every 20 of all deaths in England is sepsis related.[3]. C-reactive protein (CRP) was available as a point-of-care (POC) test in 34.4% of the cases who were referred and in 57.1% of the cases treated with antibiotics. If POC CRP was available, it was used in 45.5% of the patients who were referred for a suspected respiratory tract infection and in 36.8% of the patients who were referred due to other infections. This corresponds to the higher prevalence of home visits in the referred group; a setting in which CRP tests are not available. In patients treated with antibiotics, the POC CRP was used in 63.3% of respiratory tract infections and 12.8% in other infections when available

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