RT Journal Article
SR Electronic
T1 Recognition of sepsis in primary care: a survey among GPs
JF BJGP Open
JO Br J Gen Pract Open
FD Royal College of General Practitioners
SP BJGP-2017-0965
DO 10.3399/bjgpopen17X100965
A1 Feike J Loots
A1 Roeland Arpots
A1 Rick van den Berg
A1 Rogier M Hopstaken
A1 Paul Giesen
A1 Marleen Smits
YR 2017
UL http://bjgpopen.org/content/early/2017/04/28/bjgpopen17X100965.abstract
AB Background Early 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.Aim To gain insight into the clinical decision-making process of GPs in patients with possible sepsis infections.Design & setting Survey among a random sample of 800 GPs in the Netherlands.Method Quantitative questionnaire using Likert scales.Results One 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%).Conclusion The 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.