PURPOSE: To assess the impact of chest CT on clinical decision making in immunocompetent patients admitted with CXR findings of pneumonia.
METHODS: We identified 538 patients from our admissions that underwent chest CT between 1/05 and 1/07.Reports of CXR within 24h before CT were reviewed to identify patients with findings of pneumonia. The following were the exclusion criteria: recommendation of CT on CXR report and immunocompromised status on chart review.37 patients met the inclusion criteria 12 women and 25 men with a mean age of 56years. Age and sex-matched controls from the floor admissions with CXR findings of pneumonia that did not undergo CT were identified. Charts were reviewed for clinical presentation, management, and follow-up. Groups were compared using Fisher exact and paired Student's t tests.
RESULTS: The patients were sicker than the controls with more signs and symptoms including auscultation abnormalities, 95% (35of 37) vs 51% (19 of 37), abnormal sputum 41% (15 of 37) vs 9% (3 of 37), hypoxemia 57% (21 of 37) vs 2% (1 of 37), weight loss, 11% (4 of 37) vs 2% (1 of 37), and night sweats, 22% (8 of 37) vs 2% (1 of 37; p<0.05 each). Clinical management was more extensive for patients than controls: antibiotics initiated 100% (37 of 37) vs. 47% (18 of 37) (p>0.096), antibiotics changed 8% (3 of 37), vs. 0% (p>0.089), procedures performed 14% (5 of 37) vs. 6% (2 of 37) (p>0.067), and mean length of stay was 6.5 days vs. less than 1 (p<0.05). Eleven percent (4 of 37) of the patients had alternative/additional diagnosis based on CT: lung cancer (two cases). And TB, lung nodule, and parapneumonic pleural effusion (n=1, each).
CONCLUSION: Chest CT was often useful in guiding therapy or providing an alternative diagnosis, however, radiation exposure, length of stay, over-reading of CT of the chest making patients undergo more invasive procedures and more risks have to be in mind.
CLINICAL IMPLICATIONS: Random chest CT shouldn’t be done for CAP.
DISCLOSURE: M. Chadi Alraies, None.