Imaging in severe sepsis and septic shock: is early radiological identification of occult sources of infection needed?
© Creamer and Keep; licensee BioMed Central Ltd. 2014
Published: 3 December 2014
The importance of imaging in establishing the focus of infection is recognised in current guidelines for the management of severe sepsis , with decisions regarding timing and modality of imaging left to the physicians' clinical judgement. In the emergency department (ED), clinical assessment combined with bedside investigations of chest X-ray (CXR) and urine dip can be used to confirm the two most common sources . However, they may fail to identify occult sources of infection, such as intraabdominal collections and abscesses, the treatment of which may require alteration of empirical treatment or be refractory to antibiotic therapy alone. Further imaging is necessary to confirm the focus so that optimal treatment can be achieved.
The study cohort was composed of 50 consecutive patients who met the criteria for severe sepsis  attending the ED in 2013. Electronic and paper patient records and radiology results were analysed. All radiological studies done in the first 72 hours following attendance were included in the study.
Our results indicate that simple bedside investigations are able to identify a focus of infection in 60% of patients presenting to the ED with severe sepsis. Our results support the continued use of CXR as the initial imaging modality in severe sepsis, but also demonstrate the benefit of further imaging in confirming the focus of infection and to guide definitive treatment. Instances where further imaging was delayed by several days highlight the need for guidelines detailing which investigations should be done and in what time frame.
- Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al.: Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013, 39: 165-228. 10.1007/s00134-012-2769-8View ArticlePubMedGoogle Scholar
- Perman SM, Goyal M, Gaieski DF: Initial emergency department diagnosis and management of adult patients with severe sepsis and septic shock. Scand J Trauma Resusc Emergency Med 2012, 20: 41. 10.1186/1757-7241-20-41View ArticleGoogle Scholar
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