What Clinicians Think About When They Think About Sepsis: Results From a Survey Across the University of Maryland Medical System.

IMPORTANCE

Sepsis, a leading cause of death in the hospital, is a heterogeneous syndrome without a defined or specific set of symptoms.

OBJECTIVES

We conducted a survey of clinicians in practice to understand which clinical findings they tend to associate with sepsis.

DESIGN, SETTING, AND PARTICIPANTS: A survey was distributed to physicians and advanced practice providers across a multihospital health system during April 2022 and May 2022 querying likelihood of suspecting sepsis and initiating sepsis care in response to various normal and abnormal clinical findings.

ANALYSIS

Strength of association between clinical findings and suspicion of sepsis were based on median and interquartile range of complete responses. Comparisons between individual questions were performed using Wilcoxon rank-sum testing.

RESULTS

Among 179 clinicians who opened the survey, 68 (38%) completed all questions, including 53 (78%) attending physicians representing six different hospitals. Twenty-nine respondents (43%) worked primarily in the ICU, and 16 (24%) worked in the emergency department. The clinical findings most strongly associated with suspicion of sepsis were hypotension, tachypnea, coagulopathy, leukocytosis, respiratory distress, and fever. The abnormal clinical findings least likely to prompt suspicion for sepsis were elevated bilirubin, elevated troponin, and abdominal examination suggesting ileus. On average, respondents were more likely to suspect sepsis with high temperature than with low temperature (p = 0.008) and with high WBC count than with low WBC count (p = 0.003).

CONCLUSIONS

Clinicians in practice tend to associate the diagnosis of sepsis with signs of severe illness, such as hypotension or respiratory distress, and systemic inflammation, such as fever and leukocytosis. Except for coagulopathy, nonspecific laboratory indicators of organ dysfunction have less influence on decision-making.