Journal Article Epublish
PubMed: 39804413 DOI: 10.1186/s13244-024-01894-3
Critical reflection on the indication for computed tomography: an interdisciplinary survey of risk and benefit management in patients with sepsis.
Insights Imaging 16(1):15
Authors: Maria Isabel Opper Hernando, Denis Witham, Ann-Christine Stahl, Peter Richard Steinhagen, Stefan Angermair, Wolfgang Bauer, Friederike Compton, Andreas Edel, Jan Matthias Kruse, York Kühnle, Gunnar Lachmann, Susanne Marz, Holger Müller-Redetzky, Jens Nee, Oliver Paul, Damaris Praeger, Carsten Skurk, Miriam Stegemann, Alexander Uhrig, Stefan Wolf, Myrto Bolanaki, Kerstin Rubarth, Joachim Seybold, Elke Zimmermann, Marc Dewey, Julian Pohlan
Affiliations
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Radiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Gastroenterology and Hepatology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, Berlin, Germany.
- Emergency Department, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, Berlin, Germany.
- Medical Clinic with Focus on Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, Berlin, Germany.
- Department of Anesthesiology and Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 and Augustenburger Platz 1, Berlin, Germany.
- Medical Clinic with Focus on Nephrology and Internal Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany.
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany.
- Interdisciplinary Anesthesiology and Surgical Intensive Care Unit, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 and Augustenburger Platz 1, Berlin, Germany.
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Clinic for Cardiology, Angiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 30, Berlin, Germany.
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Augustenburger Platz 1, Berlin, Germany.
- Department of Neurosurgery with Pediatric Neurosurgery Unit, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Emergency Department, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1 and Augustenburger Platz 1, Berlin, Germany.
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Medical Directorate, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt- Universität zu Berlin, Charitéplatz 1, Berlin, Germany.
- Department of Radiology, Oberhavel Kliniken - Oberhavel Kliniken GmbH, Academic Teaching Hospital of the Charité - Universitätsmedizin Berlin, Hennigsdorf, Germany.
- Johnson & Johnson Innovative Medicine, Janssen-Cilag GmbH, Johnson & Johnson Platz 1, Neuss, Germany.
Abstract
OBJECTIVES
To survey physicians' views on the risks and benefits of computed tomography (CT) in the management of septic patients and indications for and contraindications to contrast media use in searching for septic foci.
METHODS
A web-based questionnaire was administered to physicians at a large European university medical center in January 2022. A total of 371 questionnaires met the inclusion criteria and were analyzed with physicians' work experience, workplace, and medical specialty as independent variables. Chi-square tests were used for exploratory analysis.
RESULTS
While physicians with all levels of work experience were included, the largest group (35.0%, n = 130/371) had 3-7 years of experience. Most physicians agreed that the benefits of CT outweigh its potential adverse effects in septic patients (90.5%, n = 336/371). Responders saw the strongest indication for contrast media administration in septic patients for (1) CT examinations of the abdomen (92.7%, n = 333/359) and (2) combined CT examinations of the chest, abdomen, and pelvis (94.1%, n = 337/358). While radiologists were most likely to consider manifest hyperthyroidism an absolute contraindication to contrast media administration (43.8%, n = 14/32), most other groups of physicians opted for appropriate preparation before contrast media administration in this subset of septic patients.
CONCLUSION
In this survey, most participating physicians considered CT an essential diagnostic modality to detect an infectious focus in septic patients. Whereas the risk of ionizing radiation was regarded as justifiable by most physicians, different specialties varied in their assessment of the risks of contrast media administration.
KEY POINTS
Physicians recognize CT as a relevant imaging modality in the diagnostic management of patients with sepsis. There is an interdisciplinary consensus that the use of ionizing radiation is justified in septic patients. There is disagreement about indications for and contraindications to contrast media administration among physicians from different medical specialties.
MeSH
Contrast Media, Tomography, Contraindications, Sepsis, Work, Physicians