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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
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.
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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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