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© Research
Publication : American journal of respiratory and critical care medicine

Early Chest CT-Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-Acquired Pneumonia

Scientific Fields
Diseases
Organisms
Applications
Technique

Published in American journal of respiratory and critical care medicine - 13 Jul 2015

Claessens YE, Debray MP, Tubach F, Brun AL, Rammaert B, Hausfater P, Naccache JM, Ray P, Choquet C, Carette MF, Mayaud C, Leport C, Duval X

Link to Pubmed [PMID] – 26168322

Am. J. Respir. Crit. Care Med. 2015 Jul;

RATIONALE: Clinical decision making relative to community acquired-pneumonia CAP diagnosis is difficult. Chest X-ray is key in establishing parenchymal lung involvement. However, radiological performance may lead to misdiagnosis, rendering questionable the utility of chest CT-scan in patients with clinically-suspected CAP.

OBJECTIVE: To assess whether early multidetector chest CT-scan affects diagnosis and management of patients visiting the emergency department with suspected CAP.

METHODS: 319 prospectively enrolled patients with clinically suspected CAP patients underwent multidetector chest CT-scan within 4 hours. CAP diagnosis probability (definite, probable, possible or excluded), and therapeutic plans (antibiotic initiation/discontinuation, hospitalisation/discharge) were established by emergency physicians before and after CT scan results. The adjudication committee established the final CAP classification on day 28.

MEASUREMENTS AND MAIN RESULTS: Chest X-ray revealed a parenchymal infiltrate in 188 patients. CAP was initially classified as definite in 143 patients (44.8%), probable or possible in 172 (53.8%), excluded in 4 (1.2%). CT-scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest X-ray and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on X-ray. CT-scan modified classification in 187 (58.6% 95%CI 53.2-64.0); leading to 50.8% definite CAP and 28.8% excluded CAP; 80% of modifications were in accordance with adjudication committee classification. Due to CT-scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalisation was decided in 22 and discharge in 23.

CONCLUSIONS: In CAP-suspected patients visiting the emergency unit, early CT-scan findings complementary to chest X-ray markedly affect both diagnosis and clinical management. Clinical trial registration available at www.clinicaltrials.gov, ID NCT01574066.

http://www.ncbi.nlm.nih.gov/pubmed/26168322