Lien vers 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.