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Practising physician's knowledge and patterns of practice regarding the asplenic state: the need for improved
M L Brigden1, A Pattullo, G Brown
1Penticton Hospital Cancer Clinic, BC.
Objective:
To examine physicians' knowledge and actions regarding the asplenic state and to develop a practical checklist to aid in the systematic education and management of asplenic patients.
Design:
A prospective cohort survey utilizing an experienced nurse practitioner and a survey questionnaire with on-site interviews.
Setting:
The Okanagan Valley, British Columbia.
Subjects:
A cohort of 122 physicians serving a population base of 350,000.
Main Outcome Measures:
Beliefs and practices relating to vaccination and precautions necessary for adult and pediatric splenectomized patients.
Principal Results:
The majority of physicians appeared to be knowledgeable about potential conditions affecting splenic function, except in the case of severe liver disease with portal hypertension and collagen vascular disease. There appeared to be good understanding on the part of most physicians of the risks associated with various infectious diseases and the asplenic state, except in the case of Capnocytophaga canimorsus infection linked to dog bites and the increased susceptibility of asplenic patients to intraerythrocytic parasites. Although a majority of physicians were cognizant of the need for pneumococcal vaccination and other immunizations in adults, there was marked uncertainty in relation to the need and the appropriate time interval for revaccination. In the case of children there appeared to be uncertainty regarding the role of antibiotic prophylaxis. There were discrepancies between physicians' expressed attitudes and the actions actually taken for asplenic patients in individual practices.
Conclusions:
Further education is required concerning the management of asplenic patients. The systematic use of a practical checklist may facilitate this process.
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