Recognition of sepsis in primary care: a survey among GPs

Loots, Feike J; Arpots, Roeland; Berg, Rick van den; Hopstaken, Rogier; Giesen, Paul; Smits, Marleen

doi:10.3399/bjgpopen17x100965

Cited by 17 publications

(20 citation statements)

References 15 publications

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“…General patient appearance, gut feeling and patient history turned out to be most important for the decision whether or not to refer. [14] Our finding that the respiratory rate was higher in patients with an adverse outcome, may suggest that including this vital parameter in this decision-making process could be useful. In 2016, a NICE guideline provided recommendations for GPs when to refer patients with suspected sepsis to the hospital.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

et al. 2019

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ObjectiveResearch on serious infections/sepsis has focused on the hospital environment, while potentially the most delay, and therefore possibly the best opportunity to improve quality of care, lies in the prehospital setting. In this study we investigated the prehospital phase of adult emergency department (ED) patients with an infection.MethodsIn this prospective pilot study all adult (≥18y) patients with a suspected/proven infection, based on the notes in the patient’s ED chart, were included during a 4-week period in 2017. Prehospital course, ED findings, presence of sepsis and 30-day outcomes were registered.ResultsA total of 440 patients were identified, with a median symptom duration before ED visit of 3 days (IQR 1–7 days). Before arrival in the ED, 23.9% of patients had used antibiotics. Most patients (83.0%) had been referred by a general practitioner (GP), while 41.1% of patients had visited their GP previously during the current disease episode. Patients referred by a GP were triaged as high-urgency less often, while vital parameters were similar. Emergency Medical Services (EMS) transported 268 (60.9%) of patients. Twenty-two patients (5.0%) experienced an adverse outcome (30-day all-cause mortality and/or admission to intensive care).ConclusionsPatients with a suspected infection had symptoms for 3 (IQR 1–7) days at the moment of presentation to the ED. During this prehospital phase patients often had consulted, and were treated by, their GP. Many were transported to the ED by EMS. Future research on severe infections should focus on the prehospital phase, targeting patients and primary care professionals.

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Section: Discussionmentioning

confidence: 99%

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

et al. 2019

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“…Recording of vital signs is essential, but, compared with secondary care doctors, GPs generally use more factors such as clinical impression and gut feeling in their diagnostic work-up. 13 However, rigorous data on diagnostic accuracy and appropriateness of sepsis management in primary care are not available.…”

Section: Introductionmentioning

confidence: 99%

Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

et al. 2018

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ObjectivesTimely recognition and treatment of sepsis is essential to reduce mortality and morbidity. Acutely ill patients often consult a general practitioner (GP) as the first healthcare provider. During out-of-hours, GP cooperatives deliver this care in the Netherlands. The aim of this study is to explore the role of these GP cooperatives in the care for patients with sepsis.DesignRetrospective study of patient records from both the hospital and the GP cooperative.SettingAn intensive care unit (ICU) of a general hospital in the Netherlands, and the colocated GP cooperative serving 260 000 inhabitants.ParticipantsWe used data from 263 patients who were admitted to the ICU due to community-acquired sepsis between January 2011 and December 2015.Main outcome measuresContact with the GP cooperative within 72 hours prior to hospital admission, type of contact, delay from the contact until hospital arrival, GP diagnosis, initial vital signs and laboratory values, and hospital mortality.ResultsOf 263 patients admitted to the ICU, 127 (48.3%) had prior GP cooperative contacts. These contacts concerned home visits (59.1%), clinic consultations (18.1%), direct ambulance deployment (12.6%) or telephone advice (10.2%). Patients assessed by a GP were referred in 64% after the first contact. The median delay to hospital arrival was 1.7 hours. The GP had not suspected an infection in 43% of the patients. In this group, the in-hospital mortality rate was significantly higher compared with patients with suspected infections (41.9% vs 17.6%). Mortality difference remained significant after correction for confounders.ConclusionGP cooperatives play an important role in prehospital management of sepsis and recognition of sepsis in this setting proved difficult. Efforts to improve management of sepsis in out-of-hours primary care should not be limited to patients with a suspected infection, but also include severely ill patients without clear signs of infection.

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“…Several studies were about the predictive value of gut feelings in the area of serious infection in children29; sepsis in primary care30; children with respiratory tract infection in general practice31; use of gestalt with regard to 32PE and the role of intuition in the suspicion of cancer 33 34. All these studies used a binary question ‘do you have gut feelings?’29–31 without using a proper definition of the concept. Therefore, it is unknown how the participants had interpreted the term ‘gut feelings’ or ‘intuition’?…”

Section: Discussionmentioning

confidence: 99%

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

et al. 2020

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ObjectivesDyspnoea and chest pain are symptoms shared with multiple pathologies ranging from the benign to life-threatening diseases. A Gut Feelings Questionnaire (GFQ) has been validated to measure the general practitioner’s (GPs) sense of alarm or sense of reassurance. The aim of the study was to estimate the diagnostic test accuracy of GPs’ sense of alarm when confronted with dyspnoea and chest pain.Design and settingsProspective observational study in general practice.ParticipantsPatients aged between 18 and 80 years, consulting their GP for dyspnoea and/or chest pain, were considered for enrolment. These GPs had to complete the GFQ immediately after the consultation.Primary outcome measuresLife-threatening and non-life-threatening diseases have previously been defined according to the pathologies or symptoms in the International Classification of Primary Care (ICPC)-2 classification. The index test was the sense of alarm and the reference standard was the final diagnosis at 4 weeks.Results25 GPs filled in 235 GFQ questionnaires. The positive likelihood ratio for the sense of alarm was 2.12 (95% CI 1.49 to 2.82), the negative likelihood ratio was 0.55 (95% CI 0.37 to 0.77).ConclusionsWhere the physician experienced a sense of alarm when a patient consulted him/her for dyspnoea and/or chest pain, the post-test odds that this patient had, in fact, a life-threatening disease was about twice as high as the pretest odds.Trial registration numberNCT02932982.

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Recognition of sepsis in primary care: a survey among GPs

Cited by 17 publications

References 15 publications

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

Characteristics of the prehospital phase of adult emergency department patients with an infection: A prospective pilot study

Management of sepsis in out-of-hours primary care: a retrospective study of patients admitted to the intensive care unit

Accuracy of the general practitioner’s sense of alarm when confronted with dyspnoea and/or chest pain: a prospective observational study

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