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Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency
Chest CT-scan (CT) exceeds chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) but actual use and results remain unclear. We examine whether CT performed at ED visit improved ED diagnosis of CAP as compared to a final diagnosis of CAP at hospital discharge (gold standard diagnosis for t...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605193/ https://www.ncbi.nlm.nih.gov/pubmed/35762442 http://dx.doi.org/10.1097/MEJ.0000000000000955 |
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author | Claessens, Yann-Erick Berthier, Frédéric Baqué-Juston, Marie Perrin, Christophe Faraggi, Marc Keita-Perse, Olivia Duval, Xavier |
author_facet | Claessens, Yann-Erick Berthier, Frédéric Baqué-Juston, Marie Perrin, Christophe Faraggi, Marc Keita-Perse, Olivia Duval, Xavier |
author_sort | Claessens, Yann-Erick |
collection | PubMed |
description | Chest CT-scan (CT) exceeds chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) but actual use and results remain unclear. We examine whether CT performed at ED visit improved ED diagnosis of CAP as compared to a final diagnosis of CAP at hospital discharge (gold standard diagnosis for the study), and how it impacts relevant clinical outcomes. This retrospective monocenter observational study was based on the analysis of the hospital database. Patients with a diagnosis of CAP in the ED (ICD-10 codes: J110, J111, from J12- to J18-, J440, J690, U0710, and U0711) were included. We compared ED patients who were diagnosed with CAP using CXR and CT. We measured diagnostic consistency, duration of ED visit, percentage of CXR and CT during hospital stay, hospital length-of-stay, ICU admission, and in-hospital mortality. Multivariate analysis was adjusted for CRB65 score by multiple logistic regression analysis for binary outcomes and by multivariate analysis of variance for continuous outcomes. We included 994 ED patients with an initial diagnosis of CAP (751 receiving CXR, 243 receiving CT). CT prescription in the ED increased over time (P < 0.001). In patients admitted after ED, CT improved diagnosis consistency for CAP [88.2% vs. 80.9%; difference 7.3% (95% confidence interval 1.2–13.3%)] with a trend for lower hospital length-of-stay [10.2 vs. 12.2 days; difference −2.0 (95% confidence interval −3.9 to −0.1)], but not ICU admission (P = 0.09) and in-hospital mortality (P = 0.056). Diagnosis of patients admitted with CAP improved when CT was obtained at ED visit. These results should be reproduced at a larger scale to test whether early CT conserves healthcare resources. |
format | Online Article Text |
id | pubmed-9605193 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-96051932022-10-27 Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency Claessens, Yann-Erick Berthier, Frédéric Baqué-Juston, Marie Perrin, Christophe Faraggi, Marc Keita-Perse, Olivia Duval, Xavier Eur J Emerg Med Original Articles Chest CT-scan (CT) exceeds chest X-ray (CXR) to diagnose community-acquired pneumonia (CAP) but actual use and results remain unclear. We examine whether CT performed at ED visit improved ED diagnosis of CAP as compared to a final diagnosis of CAP at hospital discharge (gold standard diagnosis for the study), and how it impacts relevant clinical outcomes. This retrospective monocenter observational study was based on the analysis of the hospital database. Patients with a diagnosis of CAP in the ED (ICD-10 codes: J110, J111, from J12- to J18-, J440, J690, U0710, and U0711) were included. We compared ED patients who were diagnosed with CAP using CXR and CT. We measured diagnostic consistency, duration of ED visit, percentage of CXR and CT during hospital stay, hospital length-of-stay, ICU admission, and in-hospital mortality. Multivariate analysis was adjusted for CRB65 score by multiple logistic regression analysis for binary outcomes and by multivariate analysis of variance for continuous outcomes. We included 994 ED patients with an initial diagnosis of CAP (751 receiving CXR, 243 receiving CT). CT prescription in the ED increased over time (P < 0.001). In patients admitted after ED, CT improved diagnosis consistency for CAP [88.2% vs. 80.9%; difference 7.3% (95% confidence interval 1.2–13.3%)] with a trend for lower hospital length-of-stay [10.2 vs. 12.2 days; difference −2.0 (95% confidence interval −3.9 to −0.1)], but not ICU admission (P = 0.09) and in-hospital mortality (P = 0.056). Diagnosis of patients admitted with CAP improved when CT was obtained at ED visit. These results should be reproduced at a larger scale to test whether early CT conserves healthcare resources. Lippincott Williams & Wilkins 2022-06-28 2022-12 /pmc/articles/PMC9605193/ /pubmed/35762442 http://dx.doi.org/10.1097/MEJ.0000000000000955 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Original Articles Claessens, Yann-Erick Berthier, Frédéric Baqué-Juston, Marie Perrin, Christophe Faraggi, Marc Keita-Perse, Olivia Duval, Xavier Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title | Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title_full | Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title_fullStr | Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title_full_unstemmed | Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title_short | Early chest CT-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
title_sort | early chest ct-scan in emergency patients affected by community-acquired pneumonia is associated with improved diagnosis consistency |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9605193/ https://www.ncbi.nlm.nih.gov/pubmed/35762442 http://dx.doi.org/10.1097/MEJ.0000000000000955 |
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