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Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies
Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has s...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518125/ https://www.ncbi.nlm.nih.gov/pubmed/30991716 http://dx.doi.org/10.3390/jcm8040514 |
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author | Garin, Nicolas Marti, Christophe Carballo, Sebastian Darbellay Farhoumand, Pauline Montet, Xavier Roux, Xavier Scheffler, Max Serratrice, Christine Serratrice, Jacques Claessens, Yann-Erick Duval, Xavier Loubet, Paul Stirnemann, Jérôme Prendki, Virginie |
author_facet | Garin, Nicolas Marti, Christophe Carballo, Sebastian Darbellay Farhoumand, Pauline Montet, Xavier Roux, Xavier Scheffler, Max Serratrice, Christine Serratrice, Jacques Claessens, Yann-Erick Duval, Xavier Loubet, Paul Stirnemann, Jérôme Prendki, Virginie |
author_sort | Garin, Nicolas |
collection | PubMed |
description | Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has significant drawbacks. We used a cohort of 200 consecutive elderly patients admitted to the hospital for suspected pneumonia to build a simple prediction score, which was used to determine indication for performing a CT-scan. The reference diagnosis was adjudicated by experts considering all available data, including evolution until discharge and CT scan in all patients. Results were externally validated in a second cohort of 319 patients. Pneumonia was confirmed in 133 patients (67%). Area under the receiver operator curve (AUROC) of physician evaluation was 0.55 (0.46–0.64). The score incorporated four variables independently predicting confirmed pneumonia: male gender, acute cough, C-reactive protein >70 mg/L, and urea <7 mmol/L. AUROC of the score was 0.68 (95% confidence interval (CI) 0.60–0.76). When a CT-scan was obtained for patients at low or intermediate predicted risk (108 patients, 54% of the cohort), AUROC was 0.71 (0.63–0.80) and 0.69 (0.64–0.74) in the derivation and validation cohort, respectively. A simple prediction score for pneumonia had moderate accuracy and could guide the performance of a CT-scan. |
format | Online Article Text |
id | pubmed-6518125 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-65181252019-05-31 Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies Garin, Nicolas Marti, Christophe Carballo, Sebastian Darbellay Farhoumand, Pauline Montet, Xavier Roux, Xavier Scheffler, Max Serratrice, Christine Serratrice, Jacques Claessens, Yann-Erick Duval, Xavier Loubet, Paul Stirnemann, Jérôme Prendki, Virginie J Clin Med Article Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has significant drawbacks. We used a cohort of 200 consecutive elderly patients admitted to the hospital for suspected pneumonia to build a simple prediction score, which was used to determine indication for performing a CT-scan. The reference diagnosis was adjudicated by experts considering all available data, including evolution until discharge and CT scan in all patients. Results were externally validated in a second cohort of 319 patients. Pneumonia was confirmed in 133 patients (67%). Area under the receiver operator curve (AUROC) of physician evaluation was 0.55 (0.46–0.64). The score incorporated four variables independently predicting confirmed pneumonia: male gender, acute cough, C-reactive protein >70 mg/L, and urea <7 mmol/L. AUROC of the score was 0.68 (95% confidence interval (CI) 0.60–0.76). When a CT-scan was obtained for patients at low or intermediate predicted risk (108 patients, 54% of the cohort), AUROC was 0.71 (0.63–0.80) and 0.69 (0.64–0.74) in the derivation and validation cohort, respectively. A simple prediction score for pneumonia had moderate accuracy and could guide the performance of a CT-scan. MDPI 2019-04-15 /pmc/articles/PMC6518125/ /pubmed/30991716 http://dx.doi.org/10.3390/jcm8040514 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Garin, Nicolas Marti, Christophe Carballo, Sebastian Darbellay Farhoumand, Pauline Montet, Xavier Roux, Xavier Scheffler, Max Serratrice, Christine Serratrice, Jacques Claessens, Yann-Erick Duval, Xavier Loubet, Paul Stirnemann, Jérôme Prendki, Virginie Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title | Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title_full | Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title_fullStr | Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title_full_unstemmed | Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title_short | Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies |
title_sort | rational use of ct-scan for the diagnosis of pneumonia: comparative accuracy of different strategies |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6518125/ https://www.ncbi.nlm.nih.gov/pubmed/30991716 http://dx.doi.org/10.3390/jcm8040514 |
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