Most students reported the SOFA score as a diagnostic criterion of sepsis. A considerable minority opted for the SIRS criteria as diagnostically relevant. The majority of participants who opted for a SOFA sore being relevant for diagnosing sepsis also considered the score’s result as an indication for a CT scan. The ability to plan an intervention or surgery and confirm a suspected focus of sepsis were considered great benefits of CT scans. Students also perceived the benefit of CT as a rule-out diagnostic test. Most students rated a known severe allergic reaction to contrast agents as an absolute contraindication to its administration. Most students were also aware of radiation exposure as an important disadvantage of CT scans.

To our knowledge, we present the first survey of final-year medical students’ perspectives on the use of CT in patients with sepsis. Our results partially reflect a lack of knowledge regarding the Surviving Sepsis Campaign (SSC) guidelines among students, as recently reported by Marshall-Brown et al. [13]. A significant minority of our participants considered the SIRS criteria relevant for sepsis diagnosis and, therefore, would rely on outdated diagnostic criteria [19]. Additionally, in the SSC guidelines from 2021, the SIRS score was considered not specific enough and, therefore, not optimal as a single screening tool to identify sepsis [19]. There is an ongoing debate about which score provides the highest accuracy for diagnosing sepsis [19]. In accordance with the Sepsis-3 definition from 2016, most students in our survey assessed the SOFA score as diagnostically relevant [2]. Due to the severity of sepsis, teaching the updated guidelines should be a given. Medical schools need to teach the principles and guidelines, but hospitals where final-year medical students work, should also be responsible for providing current and updated information relevant to treatment. Re-education or re-training on sepsis and CT of students in the later stages of their medical studies may be necessary.

While 65.4% of the participants in the study of Alchallah et al. stated an allergic reaction to contrast media as a contraindication for a CT scan in general, a comparable number of our study’s participants rated a severe allergic reaction to contrast agents as an absolute contraindication but solely for the administration of contrast agents not for a CT scan [20]. In the ESUR guideline on contrast agents, a severe allergic reaction to a contrast agent in the past has been classified as a risk factor, and the use of alternative contrast agents or imaging modalities is recommended [21]. In cases of manifest hyperthyroidism, the guidelines advise against the administration of a contrast agent, whereas only 35% of our study participants classified it as an absolute contraindication [21].

Alchallah et al. described misconceptions about radiation exposure during specific procedures, particularly regarding the dose of a CT scan [20]. Similar results were found by Prezzia et al., who reported poor knowledge about radiation exposure and safety in fourth-year medical students [18]. Conversely, we found a high general awareness of radiation exposure as a disadvantage and risk from CT scans in our student population. Similar to our results, Maharjan et al. assessed the basic level of radiation knowledge as adequate [22]. In contrast to Alchallah et al. and Prezzia et al., we did not ask specific questions about radiation doses and exposure. In compliance with the Radiation Safety Commission’s Guidance on Imaging Studies and the Guidelines for the Referral for Imaging Procedures of the European Union Commission, most participants in our survey favored a CT scan of the trunk, i.e., chest plus abdomen and pelvis, despite the radiation exposure [23, 24]. Besides, based on several studies that localized the most common septic sources to the lungs, abdomen, and genitourinary tract, our group previously showed that these were well identified in CTs of the trunk [10, 11]. De Waele et al. recommend that a CT scan should be considered for focus search in sepsis, especially when there is no clinical improvement [25]. Over half of our participants opted against a repeat CT if the patient’s clinical condition was stable. At the same time, a vast majority would request a repeat CT in case of clinical deterioration. There is an ongoing debate on whether a CT examination should be performed to confirm an obvious focus [25], which is advocated by a minority of students in this survey.

We recently published data from a version of this survey conducted by medical doctors from various disciplines elsewhere [26]. Medical doctors rated the examination of the chest or abdomen according to clinical assessment higher than MD students at 43%. Secondly, the chest, abdomen, and pelvis were opted by medical doctors in 35%. The second part of that survey is currently unpublished.

Essentially, radiology plays a central role in the diagnostic management of patients with sepsis as to identify the infectious focus. All further management will be based on the imaging results, as these are immediately available as opposed to microbiology. Universities and undergraduate studies should account for this central role and adapt curricula to the needs of patient care for junior doctors to be sufficiently trained.

The present study analyzes data from participants of one university clinic and may not reflect the situation at other universities and countries. However, the high proportion of external participants allows conclusions to be drawn about the perspective of final-year medical students who have not only studied at other medical faculties prior to their final year, but also have undergone the regular curriculum teaching. Since parts of the survey’s items were not completed, bias can be assumed. In conjunction with other indicators, leaving blanks seems to reflect uncertainty about the topic of the study among participants. Several participants independently indicated they had no experience and were relatively unfamiliar with certain aspects of the questionnaire. This study focused on self-reported understanding of the use of CT in septic patients and thus did not assess students’ skills at a bedside level or their knowledge of evidence-based guidelines. Due to the limited number of items, the questionnaire may not have been able to capture all aspects of students’ perspectives on the use of CT in sepsis. The results may not represent all medical students as only final-year medical students were surveyed. Due to the small number of students with previous radiological experience in this study, conclusions about the influence of this co-variable carry little weight. Differences between radiology-experienced and radiology-inexperienced students might become evident in a larger number of participants. This study did not analyze the role of other imaging modalities such as ultrasound and X-ray in detail. Further studies should assess students’ knowledge of imaging indications and a stepwise approach to manage patients with infections.