Sepsis herkennen in de huisartsenzorg: diagnostische en prognostische studie ter evaluatie van de meerwaarde van point-of-care testing

Diagnosing sepsis in ambulatory primary care is challenging for GPs. The
pre-hospital detection is known to be poor while early detection is important
to prevent adverse outcome. Adaptation of diagnostic strategies from hospital
settings, designed to include all sepsis patients for early treatment and
further work-up, adheres the risk of a substantial increase of unnecessary
referrals. Therefore diagnostic research in the primary care setting is needed
to improve the detection in a cost-efficient manner. With the advent of POCT,
these tests can now also be implemented in ambulatory primary care and even
during home visits.

Our hypothesis is that a structured use of clinical features in combination
with blood tests applicable as POC-tests, can improve recognition and outcome
in sepsis patients.

The objective of the study is to improve the detection of sepsis in primary
care by developing a clinical decision rule for GPs, consisting of the most
relevant clinical features and point-of-care (POC) measurements of biomarkers.
This decision rule will help to decrease mortality and morbidity from sepsis as
well as reduce unnecessary referrals.

Prospective, multicentre, diagnostic and prognostic study.

From all patients venous blood samples (22 ml total) will be obtained once
directly after inclusion. A single questionnaire is send to all patients 30
days after inclusion. The burden for the included patients is therefore limited
and involves a negligible risk. The target population are largely frail elderly
patients, and some may be incapacitated due to the acute illness. Excluding the
most severely ill patients must be prevented to be able to develop a valid
clinical decision rule. Therefore, the screening procedures for patient
recruitment have been designed to prevent selection bias without compromising
informed consent or medical treatment.