Sepsis: a study of physician's knowledge about the Surviving Sepsis Campaign in Puerto Rico

Background

In recent years, an increase incidence of sepsis has been reported. The literature suggests that over 650,000 cases of sepsis are diagnosed annually in the United States, leading to more than 100,000 deaths.

Despite medical and technological advances in treatment, the overall mortality rate in most institutions has remained between 40 and 45%. In 2003, a group of international critical care and infectious diseases physicians gathered to develop guidelines to improve the outcome of patients with sepsis. At the end of that year the Surviving Sepsis Campaign (SSC) Guidelines were published for sepsis management.

Objective

To measure the degree of physician's knowledge of the SSC management guidelines in Puerto Rico.

Methods

A validated questionnaire was given personally to 160 physicians. It included therapeutic interventions and important elements of the above guidelines. It was administered to a broad base of physicians including internal medicine and general surgery along with subspecialties from public and private hospitals around the entire island.

The questionnaire included a total of 13 questions. Questions 1–4 address general knowledge regarding the SSC and its goals. Question 5 measures knowledge of the diagnostic criteria for SIRS. Question 6 addresses outcome of severe sepsis. Questions 7–13 look at the specific guidelines.

Results

Although 90% of all responders knew of the published guidelines, 60.1% and 36.8% had heard of the SSC or the sepsis bundles, respectively. Only 31.4% correctly identified SIRS criteria. Of the questions concerning bundle components, the worst scores were on those focused on use of steroids (32.5%), glucose control (40.9%) and ventilation (46%). Regarding our institution, which is a teaching hospital, there was no statistically significant difference in the percentage of correct answers between postgraduate year PGY-1 and PGY-2 residents (P = 0.51) or PGY-3 residents (P = 0.61). No significant differences were found between attending physicians and PGY-3 residents (P = 0.80).

Conclusion

Recognizing septic patients remains a clinical challenge. Our results revealed no difference in knowledge between in-training doctors and private physicians. This is quite unexpected, as one would anticipate improved knowledge through years of training. These results prove that future strategies to correct these deficiencies are needed.