Rapid identification of the infectious focus remains central to the clinical management of sepsis, where early diagnostic clarification supports timely therapeutic intervention. Contrast-enhanced computed tomography (CECT) is frequently used in emergency settings to confirm suspected infection sources and guide treatment decisions such as antibiotic selection, surgical intervention or interventional procedures. Despite its widespread clinical application, the precise role of CECT in sepsis pathways remains insufficiently defined in current clinical guidance. A European Emergency Radiology survey conducted among members of the European Society of Emergency Radiology (ESER) explored how emergency radiologists perceive the timing, indications and contraindications of CECT in patients with sepsis, and how these perspectives compare with those of clinicians and general radiologists.
Diagnostic Role of CECT in Sepsis
The diagnosis of sepsis relies primarily on clinical assessment and laboratory findings, although screening tools have limited diagnostic accuracy. Clinical evaluation may be particularly challenging in patients unable to cooperate because of complications such as septic encephalopathy. Imaging therefore plays an important complementary role in identifying infectious foci and supporting therapeutic decision-making in emergency care environments.
Guidelines consistently emphasise early identification of infection sources and prompt initiation of antimicrobial therapy, yet they do not specify how CECT should be integrated into diagnostic workflows for sepsis. Evidence from clinical practice indicates that CECT contributes substantially to confirming suspected infection sources and guiding downstream clinical management. Its relevance is particularly pronounced in emergency radiology, where rapid diagnostic clarification can influence immediate treatment planning.
To better understand specialist perspectives, a structured questionnaire was distributed to ESER members between January and May 2023. The questionnaire, previously validated through testing with final-year medical students and physicians in a university medical centre, focused on timing, indications and contraindications of CECT in sepsis. Responses were analysed together with data from earlier surveys involving clinicians and general radiologists. In total, 719 participants were included, comprising 144 emergency radiologists, 518 clinicians and 57 general radiologists. Most emergency radiologists were board-certified physicians and more than 70% reported over 11 years of professional experience, reflecting a highly experienced cohort in emergency imaging practice.
Must Read:Kidney Cancer CT Model Predicts Key Pre-Surgical Factors
Timing and Repeat Imaging Decisions
Across professional groups, most respondents supported performing CECT within a relatively short time window after diagnosing sepsis. Among emergency radiologists, the most frequently preferred interval was between one and six hours after diagnosis, representing 45.8% of respondents who answered this item. Similar preferences were observed among clinicians and general radiologists, where values ranged from 45.8% to 57.1% across groups.
Emergency radiologists showed greater acceptance of delayed imaging compared with other professional groups. More than one-third of emergency radiologists, representing 35.6% of respondents to the timing question, considered intervals longer than twelve hours acceptable. In comparison, 14.3% of general radiologists and 3.2% of clinicians selected this option. No emergency radiologist preferred imaging within less than one hour. These findings highlight variation in operational priorities between specialties involved in sepsis care.
Differences also emerged regarding repeat imaging. Emergency radiologists more frequently supported repeating CT examinations in patients with sepsis who experience clinical deterioration. Strong agreement with repeat imaging was reported by 35.3% of emergency radiologists responding to this item, compared with 8.6% of general radiologists and 2.9% of clinicians. Only a negligible proportion of emergency radiologists strongly disagreed with repeat imaging in such scenarios.
These variations occurred alongside differences in professional experience between groups. Emergency radiologists generally had longer clinical experience than clinicians and general radiologists included in the comparison dataset. Stratified analyses according to professional experience and board-certification status indicated differences across subgroups but did not demonstrate substantial bias in the overall findings.
Contraindications and Interdisciplinary Variation
Perspectives on contraindications for CECT showed both agreement and divergence across specialties. Most respondents considered CECT feasible after appropriate preparation in patients with prior mild acute adverse reactions to contrast media. Emergency radiologists, however, were more cautious in patients with previous severe acute adverse reactions, with 71.2% supporting classification as an absolute contraindication, compared with 41.2% of general radiologists and 43.2% of clinicians.
Responses also differed in patients with thyroid disorders. General radiologists and clinicians frequently supported performing CECT after preparation in patients with latent hyperthyroidism, whereas emergency radiologists most often selected either no contraindication or CECT after preparation, representing 70.7% of responses combined. In cases of manifest hyperthyroidism, clinicians most commonly favoured imaging after preparation, while half of general radiologists and a plurality of emergency radiologists considered the condition a relative contraindication.
Kidney function represented another area of variation. Emergency radiologists more frequently regarded impaired renal function as a relative or absolute contraindication compared with clinicians and general radiologists. Relative contraindications were reported by 44.6% of emergency radiologists and absolute contraindications by 18.5%. Opinions regarding CECT in patients with end-stage kidney disease requiring dialysis varied widely across all professional groups, with emphasis placed by some respondents on the importance of preparatory measures such as hydration.
Radiation exposure was generally not considered a major contraindication in the context of sepsis imaging. Most participants across all specialties strongly disagreed with the notion that radiation should prevent imaging in septic patients. Nevertheless, a higher proportion of emergency radiologists agreed with this concern compared with clinicians, at 22.1% versus 8%.
Perspectives from emergency radiologists across Europe indicate broad agreement on the clinical importance of performing contrast-enhanced computed tomography promptly in patients with sepsis. Differences between emergency radiologists, clinicians and general radiologists were observed in acceptable imaging time windows, repeat imaging decisions and selected contraindications. These findings highlight the complexity of balancing diagnostic urgency with patient safety considerations in emergency care environments. Greater interdisciplinary alignment in diagnostic workflows may support more consistent imaging strategies in sepsis management while preserving the benefits of rapid focus identification and treatment guidance.
Source: European Radiology
Image Credit: iStock
