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J. Clin. Med. 2019, 8(4), 514;

Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies

Department of Internal Medicine, Riviera-Chablais Hospitals, 1870 Monthey, Switzerland
Department of Internal Medicine, Geneva University Hospitals, 1205 Geneva, Switzerland
Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
Department of Radiology, Geneva University Hospitals, 1205 Geneva, Switzerland
Department of Rehabilitation and Geriatrics, Geneva University Hospitals, 1205 Geneva, Switzerland
Department of Anesthesiology, Pharmacology and Intensive Care, Geneva University Hospitals, 1205 Geneva, Switzerland
Department of Emergency Medicine, Centre Hospitalier Princesse Grace, 98000 Monaco, Monaco
Department of Infectious Disease, Bichat-Claude Bernard University Hospital, 75877 Paris, France
INSERM, IAME, UMR 1137, 75870 Paris, France
Author to whom correspondence should be addressed.
These authors contributed equally to this paper.
Received: 5 March 2019 / Revised: 5 April 2019 / Accepted: 12 April 2019 / Published: 15 April 2019
(This article belongs to the Section Nuclear Medicine & Radiology)
PDF [438 KB, uploaded 25 April 2019]
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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. View Full-Text
Keywords: clinical prediction model; lower respiratory tract infection; CT-scan clinical prediction model; lower respiratory tract infection; CT-scan

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Garin, N.; Marti, C.; Carballo, S.; Darbellay Farhoumand, P.; Montet, X.; Roux, X.; Scheffler, M.; Serratrice, C.; Serratrice, J.; Claessens, Y.-E.; Duval, X.; Loubet, P.; Stirnemann, J.; Prendki, V. Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies. J. Clin. Med. 2019, 8, 514.

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