Clinical Report: Physician Perspectives on CT Use in Sepsis at a Major Academic Center

Overview

A survey of 371 physicians at a large European university hospital assessed multidisciplinary views on the role of computed tomography (CT) in sepsis management. The study highlights the perceived benefits, clinical criteria for CT use, prioritized imaging regions, and preferred timing for CT in septic patients.

Background

Sepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection, requiring early detection and treatment to improve outcomes. Identifying the infection source promptly is critical for targeted therapy and source control. While imaging is recommended to confirm or exclude infection foci, current sepsis guidelines lack specific recommendations on imaging modalities, timing, and clinical indications. CT is frequently used due to its rapid, high-resolution full-body imaging capabilities, especially for chest, abdomen, and pelvis evaluation in sepsis.

Data Highlights

Of 2502 physicians contacted, 575 participated (23.0% gross response rate), with 371 completing all questions (14.8% net response rate). Participants included assistant, board-certified, senior, and chief physicians across specialties. The survey used a 4-point Likert scale to assess agreement on CT benefits, clinical criteria, organ region prioritization, and timing preferences for CT and CT-guided interventions in sepsis.

Key Findings

• Physicians generally agree that CT provides major benefits in identifying infection sources in sepsis.
• Commonly prioritized organ regions for CT imaging in sepsis are chest, abdomen, and pelvis, with some favoring inclusion of head and neck depending on clinical context.
• Preferred timing for CT scans in sepsis is within 1 to 6 hours after diagnosis or suspicion to facilitate early source control.
• CT results significantly influence clinical decision-making in emergency care settings for septic patients.
• There is variability in CT use based on physician specialty, experience, and workplace, reflecting multidisciplinary perspectives.

Clinical Implications

CT imaging should be considered early in the diagnostic workup of sepsis to localize infection foci, particularly in the chest, abdomen, and pelvis. Timely CT within the first 6 hours may optimize source control interventions. Multidisciplinary collaboration is essential to tailor imaging strategies based on clinical presentation and resource availability.

Conclusion

This survey underscores the recognized value of CT in sepsis management among diverse physicians and highlights the need for standardized guidelines on imaging indications and timing. Early, targeted CT imaging can enhance diagnostic accuracy and guide effective treatment in septic patients.

References

1. Sepsis Definitions and Guidelines (2021) -- Surviving Sepsis Campaign
2. Imaging in Sepsis: Role of CT and Other Modalities (2022) -- Clinical Radiology Insights
3. Survey on CT Use in Sepsis -- Pohlan J et al., 2022