Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies
AbstractDiagnosing 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
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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.
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. Journal of Clinical Medicine. 2019; 8(4):514.Chicago/Turabian Style
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. 2019. "Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies." J. Clin. Med. 8, no. 4: 514.
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