Eosinophilia attention, diagnosis, treatment, and awareness in physicians: a cross-sectional survey

Abstract

Background: Patients with incidental eosinophilia is becoming increasingly common in clinical practice. But it remains challenging to diagnose and treat owing to its complex etiology. The awareness of physicians and the strategies of diagnosis and treatment toward eosinophilia are still unclear.

Objective: We aimed to evaluate attention, diagnosis, treatment, and awareness of eosinophilia among physicians, as well as factors influencing clinical practice, and to find ways to improve the efficacy of this disease.

Design: This is a cross-sectional survey.

Methods: A cross-sectional study was conducted from 1 to 4 June 2021 in a tertiary hospital. Self-administered and validated electronic questionnaire was used to investigate the attention toward eosinophilia, the strategies of diagnosis and treatment, and the awareness in physicians.

Results: A total of 607 valid questionnaires were collected, with a response rate of 84.5%. Among the responders, 65.4% of physicians claimed to be familiar with patients with eosinophilia but only 11.0% of them had read the relevant guidelines or expert consensus. Among 207 physicians who had ever diagnosed patients with eosinophilia, only 19.4% had performed detailed examinations. The accuracy of awareness questions was 1.6-53.5%, and only 26.5% of physicians had high levels of awareness. An increase in the awareness level of up to 2.82 folds was seen among physicians with factors such as job title, encountering patients with eosinophilia, linking patients' conditions to peripheral blood eosinophil count, and paying attention to guidelines.

Conclusion: This study highlighted the importance of raising awareness and knowledge of eosinophilia among physicians in China. More works on education about eosinophilia guideline are needed, which may help physicians make decision with more benefits to patients.

Keywords: attention; awareness; diagnosis; eosinophilia; questionnaire.

Figure 1.

Examinations and treatments performed by physicians. (a) The percentage of physicians who encountered patients with eosinophilia. (b) The percentage of physicians who examined patients with eosinophilia (n = 607). (c) The percentage of physicians who chose the initial examinations (n = 154). (d) The proportion of physicians choosing specialist examinations (n = 154). (e) The treatment would be chosen (n = 607). a, routine biochemistry tests, including liver and renal function, electrolyte, and LDH; b, serum IgE tests; c, parasitic worm tests; d, circulatory system tests (ECG, echocardiography, serum troponin T, myocardial enzymes); e, autoimmunity antibodies; f, coagulation function and D-dimer tests; g, abdominal ultrasound; h, serology and stool examination for bacteria, virus, and other pathogen; i, thyroid function tests; j, serum aldosterone-level test; k, bone marrow aspiration and smear and bone marrow biopsy; l, biopsy of affected tissues; m, further examinations targeting involved organs; n, flow cytometry; o, PDGFA, JAK2, and other gene mutation tests; p, serum vitamin B₁₂ and serum tryptase; q, do not know how to arrange for tests; r, treat the primary disease; s, continue with observation if the patient is asymptomatic or if there is no clear organ involvement or dysfunction; t, do not know how to order for treatment; u, diagnostic anthelmintic treatment when needed; v, glucocorticoids; w, monoclonal antibody; x, tyrosine kinase inhibitors.

Figure 2.

Management of eosinophilia cases. (a) The percentage of answers on various diagnostic and therapeutic methods (n = 607). (b) Consultation department selected by physicians (n = 463). (c) Medical history was asked by physicians (n = 419). a, did not know what examinations or tests to order; b, administering glucocorticoids immediately; c, scheduling for targeted examinations; d, ruling out organ dysfunction; e, detailed history taking; f, consultation meeting; g, allergic and medical history; h, history of rashes, pruritus, or lymphadenopathy; i, history of eating food such as sashimi, measly pork, snake gallbladder, and conches; j, history of infectious diseases and symptoms (such as parasites, viruses, bacteria, tuberculosis, and fungi); k, history of the respiratory diseases and symptoms; l, history of hematologic diseases and symptoms; m, travel history, particularly to tropical regions; n, skin nodules or rashes; o, history of having pets or working in the livestock husbandry and slaughter industries; p, fever, night sweats, and weight loss; q, history of the cardiovascular diseases and symptoms; r, history and symptoms of digestive system.

Figure 3.

Awareness of physicians. (a) In the bar chart, blue shows the percentage of physicians who answered correctly, and red shows the percentage of physicians who answered incorrectly (n = 607). (b) The pie chart shows the physicians’ responses to organ damage caused by eosinophilia, with red indicating the percentage of physicians who answered correctly in all cases (n = 325).

Figure 4.

Pareto chart of eosinophilia relevant disease. a, allergic diseases; b, familial eosinophilia; c, parasitic infections; d, skin disease; e, infectious diseases; f, myeloproliferative neoplasms and leukemia; g, drug reaction; h, rheumatic disorders; i, pulmonary diseases; j, lymphomas; k, gastrointestinal disorders; l, vasculitis; m, solid tumors; n, I don’t know; o, others. The ‘numbers’ indicates the number of people who chose the item.

Figure 5.

The odds ratio and the 95% confidence interval for the variables associated with awareness toward eosinophilia.

Figure 6.

Comparison of treatment measures between physicians with high awareness and those with low awareness. *p < 0.05 †A comparison of the number of people selected within the group (p < 0.001).