Practising physician's knowledge and patterns of practice regarding the asplenic state: the need for improved education and a practical checklist

Objective: To examine physicians' knowledge and actions regarding the asple nic state and to develop a practical checklist to aid in the systematic edu cation and management of asplenic patients. Design: A prospective cohort su rvey utilizing an experienced nurse practitioner and a survey questionnaire with onsite interviews. Setting: The Okanagan Valley, British Columbia. Su bjects: A cohort of 122 physicians serving a population base of 350 000. Ma in outcome measures: Beliefs and practices relating to vaccination and prec autions necessary for adult and pediatric splenectomized patients. Principa l results: The majority of physicians appeared to be knowledgeable about po tential conditions affecting splenic function, except in the case of severe liver disease with portal hypertension and collagen vascular disease. Ther e appeared to be good understanding on the part of most physicians of the r isks associated with various infectious diseases and the asplenic state, ex cept 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 fo r pneumococcal vaccination and other immunizations in adults, there was mar ked uncertainty in relation to the need and the appropriate time interval f or revaccination. In the case of children there appeared to be uncertainty regarding the role of antibiotic prophylaxis. There were discrepancies betw een physicians' expressed attitudes and the actions actually taken for aspl enic patients in individual practices. Conclusions: Further education is re quired concerning the management of asplenic patients. The systematic use o f a practical checklist map facilitate this process.