Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia

Claessens, Yann-Érick; Debray, Marie‐Pierre; Tubach, Florence; Brun, Anne-Laure; Rammaert, Blandine; Hausfater, Pierre; Naccache, Jean‐Marc; Ray, Patrick; Choquet, Christophe; Carette, Marie-France; Mayaud, C; Leport, Catherine; Duval, Xavier

doi:10.1164/rccm.201501-0017oc

Cited by 251 publications

(227 citation statements)

References 31 publications

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“…Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP. They found up to 30% false positive and false negative rate of CXR in emergency department (ED), which doubted the value of CXR on pneumonia diagnosis (5). Thus, it's reasonable to figure out the alternative way to provide promising imaging evidence of pneumonia.…”

Section: Original Articlementioning

confidence: 99%

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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Background: Pneumonia is usually presented as a forgotten killer, and an early diagnosis could largely improve the prognostic outcomes. Lung ultrasound (LUS) has been universally applied in evaluating multiple pulmonary diseases including pneumonia. However, the diagnosis accuracy of LUS for pneumonia in adults is still uncertain. Hence, we performed a systematic review of the current literature to assess the diagnosis accuracy of LUS for pneumonia in adults.Methods: PubMed and EMBASE were searched for clinical trials that assessed the detection accuracy of LUS for pneumonia in adult patients. We extracted descriptive and quantitative information from eligible studies that met strict inclusion criteria and calculated pooled sensitivity, specificity and pooled diagnostic likelihood ratios (LR). Summary receiver operating characteristic (sROC) curve was used to assess the overall performance of LUS-based assays.Results: We reviewed 1,072 articles and selected 38 for detailed review. 14 articles containing 1,911 participants met all inclusion criteria and were included in the final analysis. LUS exhibited a pooled sensitivity of 0.904 (0.884-0.921), specificity of 0.884 (0.861-0.904), positive LR of 6.6 (3.7-11.7), negative LR of 0.08 (0. 04-0.19) and the area under curve (AUC) was 0.9611. Interestingly, when CT alone, CT combined with clinical presentations, and microbiology was set as the gold standard of pneumonia respectively, LUS demonstrated a pooled sensitivity of 90.9%, 95.0%, 53.3%, and a pooled specificity of 89.7%, 91.3% and 67.9%. In extension, we compared the diagnostic efficiency of LUS for pneumonia with chest X-ray (CXR) in 1,343 patients. The AUC for LUS and CXR was 0.972 and 0.867 respectively and the Z statistic of the two sROC curves was 2.31.Conclusions: Our study indicated that LUS is a robust diagnostic tool for pneumonia with high accuracy.Utilization of LUS would facilitate the estimation of pneumonia at bedside. be based on swift and accurate recognition. The signs and symptoms localizing to the respiratory system, commonly referring as dyspnea, cough and fever, laboratory alterations (leukocytosis and increased c-reactive protein/procalcitonin) in conjunction with radiographic pulmonary infiltrate, point to convincing diagnosis of pneumonia. Imaging evaluation approaches recommended on current guidelines are chest radiograph and chest computerized tomography (CT) (2,3). However, limitations for their use exist (4). Surprisingly, a recent study compared CXR to chest CT scan for suspected CAP. They found up to 30% false positive and false negative rate of CXR in emergency department (ED), which doubted the value of CXR on pneumonia diagnosis (5). Thus, it's reasonable to figure out the alternative way to provide promising imaging evidence of pneumonia.Ultrasonography is gaining more attention in critical care and emergency medicine. A good body of studies has proven that ultrasonography is highly effective in evaluating multiple pulmonary diseases, such as metastatic lymph node of lung c...

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Section: Original Articlementioning

confidence: 99%

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Yang¹,

Ying²,

Wang³

et al. 2016

J. Thorac. Dis.

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“…Even chest radiography is probably an imperfect gold standard (3). Clinicians must balance between the delay needed to secure the diagnosis, and early administration of antibiotics for prognostic reasons.…”

Section: Optimal Time To Antibiotic Initiationmentioning

confidence: 99%

Community-acquired pneumonia: the elusive quest for the best treatment strategy

Garin

Marti

2016

J. Thorac. Dis.

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“…The diagnosis of pneumonia is based on clinical symptoms or signs of lower respiratory tract infection and the presence of a new infiltrate on imaging studies that cannot be explained by any other cause [1]. Although chest radiography (CR) has traditionally been used as the initial imaging modality for the evaluation of pneumonia [2], its interobserver agreement for the diagnosis of pneumonia is not perfect [3].…”

Section: Introductionmentioning

confidence: 99%

“…Delayed diagnosis and management of pneumonia may lead to significant morbidity and mortality [5]. Chest computed tomography (CT) has been reported to be superior to CR for the visualization of lung parenchymal lesions and pleural abnormalities observed in pneumonia [1, 5-8]. In addition, CT images may be helpful in suggesting specific causative agents of pneumonia and excluding noninfectious diseases although their roles are limited [9].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, CT images may be helpful in suggesting specific causative agents of pneumonia and excluding noninfectious diseases although their roles are limited [9]. CT images can also detect comorbid thoracic or pulmonary conditions [1]. Given that CT provides additional benefits for the diagnosis of pneumonia and facilitates its characterization, it is likely to be helpful when pneumonia on CR cannot be diagnosed definitively from CR.…”

Section: Introductionmentioning

confidence: 99%

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Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

et al. 2019

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Background: Data regarding community-acquired pneumonia (CAP) identified on chest computed tomography (CT) but not on chest radiography (CR) are limited. Objectives: The present study aimed to investigate the clinical and radiological features of these patients. Methods: We retrospectively compared the clinical characteristics, etiological agents, treatment outcomes, and CT findings between CAP patients with negative CR and positive CT findings (negative CR group) and those with positive CR as well as CT findings (control group). Results: Of 1,925 patients, 94 patients (4.9%) were included in the negative CR group. Negative CR findings could be attributed to the location of the lesions (e.g., those located in the dependent lung) and CT pattern with a low attenuation, such as ground-glass opacity (GGO). The negative CR group was characterized by a higher frequency of aspiration pneumonia, lower incidences of complicated parapneumonic effusion or empyema and pleural drainage, and lower blood levels of inflammatory markers than the control group. On CT, the negative CR group exhibited higher rates of GGO- and bronchiolitis-predominant patterns and a lower rate of consolidation pattern. Despite shorter length of hospital stay in the negative CR group, 30-day and in-hospital mortalities were similar between the two groups. Conclusions: CAP patients with negative CR findings are characterized by lower blood levels of inflammatory markers, a higher incidence of aspiration pneumonia, and a lower incidence of complicated parapneumonic effusion or empyema than those with positive CR findings. Chest CT scan should be considered in suspected CAP patients with a negative CR, especially in bedridden patients.

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Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia

Abstract: In CAP-suspected patients visiting the emergency unit, early CT scan findings complementary to chest radiograph markedly affect both diagnosis and clinical management. Clinical trial registered with www.clinicaltrials.gov (NCT 01574066).

Cited by 251 publications

References 31 publications

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Effectiveness of lung ultrasonography for diagnosis of pneumonia in adults: a systematic review and meta-analysis

Community-acquired pneumonia: the elusive quest for the best treatment strategy

Community-Acquired Pneumonia with Negative Chest Radiography Findings: Clinical and Radiological Features

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