Academic Journal
The yield of chest X-ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs
| العنوان: | The yield of chest X-ray or ultra-low-dose chest-CT in emergency department patients suspected of pulmonary infection without respiratory symptoms or signs |
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| المؤلفون: | van den Berk, Inge A. H., Lejeune, Emile H., Kanglie, Maadrika M. N. P., van Engelen, Tjitske S. R., de Monyé, Wouter, Bipat, Shandra, Bossuyt, Patrick M. M., Stoker, Jaap, Prins, Jan M. |
| المساهمون: | ZonMw, Amsterdam University Medical Centers |
| المصدر: | European Radiology ; volume 33, issue 10, page 7294-7302 ; ISSN 1432-1084 |
| بيانات النشر: | Springer Science and Business Media LLC |
| سنة النشر: | 2023 |
| الوصف: | Objective The yield of pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs is probably limited, ultra-low-dose CT (ULDCT) is known to have a higher sensitivity than Chest X-ray (CXR). Our objective was to describe the yield of ULDCT and CXR in patients clinically suspected of infection, but without respiratory symptoms or signs, and to compare the diagnostic accuracy of ULDCT and CXR. Methods In the OPTIMACT trial, patients suspected of non-traumatic pulmonary disease at the emergency department (ED) were randomly allocated to undergo CXR (1210 patients) or ULDCT (1208 patients). We identified 227 patients in the study group with fever, hypothermia, and/or elevated C-reactive protein (CRP) but no respiratory symptoms or signs, and estimated ULDCT and CXR sensitivity and specificity in detecting pneumonia. The final day-28 diagnosis served as the clinical reference standard. Results In the ULDCT group, 14/116 (12%) received a final diagnosis of pneumonia, versus 8/111 (7%) in the CXR group. ULDCT sensitivity was significantly higher than that of CXR: 13/14 (93%) versus 4/8 (50%), a difference of 43% (95% CI: 6 to 80%). ULDCT specificity was 91/102 (89%) versus 97/103 (94%) for CXR, a difference of − 5% (95% CI: − 12 to 3%). PPV was 54% (13/24) for ULDCT versus 40% (4/10) for CXR, NPV 99% (91/92) versus 96% (97/101). Conclusion Pneumonia can be present in ED patients without respiratory symptoms or signs who have a fever, hypothermia, and/or elevated CRP. ULDCT’s sensitivity is a significant advantage over CXR when pneumonia has to be excluded. Clinical relevance statement Pulmonary imaging in patients with suspected infection but no respiratory symptoms or signs can result in the detection of clinically significant pneumonia. The increased sensitivity of ultra-low-dose chest CT compared to CXR is of added value in vulnerable and immunocompromised patients. Key Points • Clinical significant pneumonia does occur in patients who have a fever, low core body ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| DOI: | 10.1007/s00330-023-09664-3 |
| DOI: | 10.1007/s00330-023-09664-3.pdf |
| DOI: | 10.1007/s00330-023-09664-3/fulltext.html |
| الاتاحة: | http://dx.doi.org/10.1007/s00330-023-09664-3 https://link.springer.com/content/pdf/10.1007/s00330-023-09664-3.pdf https://link.springer.com/article/10.1007/s00330-023-09664-3/fulltext.html |
| Rights: | https://creativecommons.org/licenses/by/4.0 ; https://creativecommons.org/licenses/by/4.0 |
| رقم الانضمام: | edsbas.259843B0 |
| قاعدة البيانات: | BASE |
| DOI: | 10.1007/s00330-023-09664-3 |
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