PURPOSE: The international initiative to reduce mortality from sepsis in five years by 25% has recommended certain guidelines.1 To be able to diagnose, manage and improve the outcome of patients, clinicians, especially those who usually come in contact with the patients first, need to be aware of criteria for identifying complicated and non-complicated sepsis, and instituting timely interventions. We sort to find out how much knowledge house staff and non critical care attendings had of the current evidence based management strategies for complicated sepsis.
METHODS: The study was conducted as a prospective survey of house officers and non critical care physicians at a university affiliated community teaching hospital. Seventy participants’ knowledge was assessed with a questionnaire consisting of six items. The questions were meant to determine awareness of definitions of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis, septic shock and management strategies using Early Goal Directed Therapy (EGDT), recombinant Activated protein C (rAPC) and ARDSNET protocol for ARDS complicating severe sepsis.
RESULTS: Results:Among all the participants 25% correctly identified the parameters for SIRS, 44% for severe sepsis and septic shock, 4.3% for organ failure and correct management strategies were identified 64% for EGDT, 48% for rAPC, and 35% for ARDSNET protocol.(Table 1) Of note is the fact that physicians who correctly identified parameters for sepsis were more likely to identify the use of rAPC and ARDSNET protocol.
CONCLUSION: The knowledge required by residents and non critical care attendings, who are usually the first responders, is inadequate in this study, for identification and instituting management strategies that have been shown to improve morbidity and mortality in severe sepsis. If our patients are to benefit from the current evidence based recommendations of the Surviving Sepsis Campaign, an intensive educational program aimed at the first responders has to be developed.
CLINICAL IMPLICATIONS: Target education on early identification of severe sepsis and management will improve adherence to sepsis guidelines and improve outcomes.
DISCLOSURE: Jay Nfonoyim, None.