A new European survey has found that radiologists and clinicians agree on the value of contrast-enhanced CT (CECT) in suspected cases of sepsis, but it has also highlighted divergence among the specialties on contraindications and acceptable time windows for imaging.
Dr. Ann-Christine Stahl, PhD, a postdoctoral research fellow and registrar in the Department of Radiology at the Charité in Berlin, her colleagues Kerstin Rubarth, PhD, and Prof. Dr. Marc Dewey, PhD, and an international team of researchers surveyed 719 participants in 2023 to analyze their perspectives on CECT in patients with sepsis. They published their findings in an article published on 26 January by European Radiology.
A key finding is that emergency radiologists may be more likely to accept clinical reasoning in specific scenarios -- such as in septic patients experiencing clinical deterioration -- in which additional imaging may be considered beneficial.
Perspectives on the timing of CECT in sepsis, by discipline.Stahl, Rubarth et al; European Radiology
Of the 719 participants, 144 were emergency radiologists, 518 were clinicians, and 57 were general radiologists. Of the 719 total, 297 were members of the European Society of Emergency Radiology (ESER).
While all respondents agreed that CECT should optimally be performed on sepsis patients within a short time window, there was disagreement among respondents on how long a time frame was acceptable. Most of the respondents (57.1%) deemed the optimal time window to be under six hours, including emergency radiologists (45.8%), although no emergency radiologists opted for the less than one hour time frame among the possible responses.
Furthermore, more emergency radiologists than others accepted a longer time window, with some emergency radiologists -- 35.9% -- deeming a time frame greater than 12 hours to be acceptable; only 14.3% of general radiologists and 3.2% of clinicians gave the same response.
Another area where there was divergence of the views of emergency radiologists with other respondents was repeated imaging. The authors pointed out that while repeated imaging is generally restricted to avoid excessive exposure of patients to ionizing radiation, “in conditions with a high mortality rate, such as sepsis, radiation exposure associated with repeat imaging appears to be justifiable.”
In their survey, clinicians were most hesitant to repeat imaging, while emergency radiologists were most likely to find repeat imaging of sepsis patients to be acceptable, with general radiologists falling in between the other two on this topic.
Perspectives on repeat CECT for patients with sepsis with clinical deterioration, by discipline.Stahl, Rubarth et al; European Radiology
Imaging of sepsis patients where CECT might be contraindicated due to risk factors such as kidney failure or hyperthyroidism was found to be another topic where there was divergence in weighing the risks and benefits among the fields (with the provision that CECT be administered “after appropriate preparation” to minimize risks).
For adverse reactions, the percentages of all three groups varied according to whether the previous acute reaction had been mild or severe.
Most general radiologists and clinicians advocated CECT in patients with latent hyperthyroidism after preparation (85.3% and 66.4%, respectively); 70.7% of emergency radiologists advocated CECT after preparation or considered it “no contraindication”. In patients with manifest hyperthyroidism, 63.9% of clinicians agreed with CECT after preparation; however, 50% of general radiologists and 36.9% of emergency radiologists considered it a “relative contraindication.”
Emergency radiologists considered impaired kidney function to be a relative or absolute contraindication for CECT (44.6% relative and 18.5% absolute contraindication), while the corresponding percentages for general radiologists were 52.9% and 2.9%, respectively, and 35.9% and 2.1%, respectively. There was also a wide range for the use of CECT in patients with end-stage kidney disease requiring dialysis (43.1% to 67.6% across all groups), although 17.4% to 26.2% of respondents underscored the importance of appropriate preparation for these sepsis patients.
Perspectives on radiation exposure in patients with sepsis, by discipline.Stahl, Rubarth et al; European Radiology
The majority of respondents among all three groups disagreed that radiation should be considered a relevant contraindication in patients with sepsis. However, more emergency radiologists (22.1%) agreed it was a contraindication than clinicians (8%) or general radiologists (17.1%).
The results of this survey suggest that “emergency radiologists are more likely to accept clinical reasoning in specific scenarios -- such as in septic patients experiencing clinical deterioration -- where additional imaging may be considered beneficial,” the authors concluded, adding that this inference is speculative and that more study is required.
Additionally, while the results show high percentages of consensus on the issue of the importance of prompt CECT in patients with sepsis, the authors noted that the differences in responses among the three fields -- emergency radiologists, general radiologists, and clinicians -- may indicate a need for increased focus on interdisciplinary alignment.
Read the survey findings on the European Radiology website.
