Fever, especially new fever within the intensive care unit (ICU) triggers an aggressive search for the source in an effort to avoid a preventable systemic inflammatory response. Computed tomography (CT) of the abdomen and/or pelvis has been utilized in this situation as a view into the “black box” in hopes of finding the cause of the fever and further guiding management. Sensitivity of abdominal CT scan in evaluation of patients with sepsis is as low as 19% in all-comers to as high as 85% in those with a suspected intra-abdominal abscess as source of fever. Despite the knowledge provided by the imaging, there are very few studies that have analyzed the utility of the abdominal/pelvic CT when done for the sole indication of fever in altering clinical decision-making. Our study examines the frequency of change in management based upon abdominal/pelvic CT for the indication of fever in ICU hospitalized patients.
We conducted a retrospective analysis of abdominal/pelvic CT scans performed in ICU patients for the sole indication of fever without physical findings (exam and laboratory) to suggest an intra-abdominal process. CT findings were extracted and cross-referenced to chart review for any post-study documented/undocumented change in management and outcome.
Of 31 patients, CT findings merited a change in management in two patients, of which one had a documented change of management.
Febrile patients in the ICU with negative physical findings did not have a clinically significant alteration of management after undergoing an abdominal/pelvic CT.
There are inherent risks both in the transportation, and contrast exposure of obtaining a CT scan for the critical, often mechanically ventilated patient. Consequently, the risks vs. benefits of obtaining an imaging study in a high-risk, critically-ill population must be discussed and though we need to be aggressive in preventing any further deterioration, we need to be realistic of the cost in health-care dollars and morbidity to the patient.
H. Farquharson, None.