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Am J Respir Crit Care Med. 2015 Oct 15;192(8):974-82. doi: 10.1164/rccm.201501-0017OC.

Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia.

Author information

1
1 Department of Emergency Medicine, Centre Hospitalier Princesse Grace, Principality of Monaco.
2
2 Department of Radiodiagnosis.
3
3 APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, University Paris Diderot, Sorbonne Paris Cité, UMR 1123 ECEVE, INSERM CIC-EC 1425, UMR 1123 ECEVE, Paris, France.
4
4 Department of Radiodiagnosis and.
5
5 Université Paris-Descartes, Sorbonne Paris Cité, APHP, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, Paris, France.
6
6 Department of Emergency Medicine, Hôpital Pitié-Salpétriêre, AP-HP et Sorbonne Universités, UPMC University Paris 06, Paris, France.
7
7 Department of Respiratory Diseases.
8
8 Department of Emergency Medicine, and.
9
9 Department of Emergency Medicine, and.
10
10 Department of Radiodiagnosis, Hôpital Tenon, Paris, France; and.
11
11 Department of Infectious Diseases, Groupe Hospitalier Bichat-Claude Bernard, Paris, France.
12
12 APHP, Hôpital Bichat, Département d'Epidémiologie et Recherche Clinique, University Paris Diderot, Sorbonne Paris Cité, UMR 1138, INSERM CIC 1425, Paris, France.

Abstract

RATIONALE:

Clinical decision making relative to community-acquired pneumonia (CAP) diagnosis is difficult. Chest radiograph is key in establishing parenchymal lung involvement. However, radiologic performance may lead to misdiagnosis, rendering questionable the use of chest computed tomography (CT) scan in patients with clinically suspected CAP.

OBJECTIVES:

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

METHODS:

A total of 319 prospectively enrolled patients with clinically suspected CAP underwent multidetector chest CT scan within 4 hours. CAP diagnosis probability (definite, probable, possible, or excluded) and therapeutic plans (antibiotic initiation/discontinuation, hospitalization/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 radiograph 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%), and excluded in 4 (1.2%). CT scan revealed a parenchymal infiltrate in 40 (33%) of the patients without infiltrate on chest radiograph and excluded CAP in 56 (29.8%) of the 188 with parenchymal infiltrate on radiograph. CT scan modified classification in 187 (58.6%; 95% confidence interval, 53.2-64.0), leading to 50.8% definite CAP and 28.8% excluded CAP, and 80% of modifications were in accordance with adjudication committee classification. Because of CT scan, antibiotics were initiated in 51 (16%) and discontinued in 29 (9%), and hospitalization was decided in 22 and discharge in 23.

CONCLUSIONS:

In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).

KEYWORDS:

chest radiograph; community-acquired pneumonia; diagnosis; emergency medicine; multidetector CT scan

PMID:
26168322
DOI:
10.1164/rccm.201501-0017OC
[Indexed for MEDLINE]

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