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Abstract: Poster Presentations |

IMPACT OF CHEST CT ON CLINICAL DECISION MAKING OF IMMUNOCOMPETENT PATIENTS ADMITTED WITH CHEST RADIOGRAPHIC FINDINGS OF PNEUMONIA FREE TO VIEW

M Chadi Alraies, MD*; Abdul Hamid Alraiyes, MD; Joseph Sopko, CCP; Samer Alhindi, MD
Author and Funding Information

Case Western Reserve University - SVCH, Cleveland, OH


Chest


Chest. 2008;134(4_MeetingAbstracts):p32001. doi:10.1378/chest.134.4_MeetingAbstracts.p32001
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Abstract

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.

Tuesday, October 28, 2008

1:00 PM - 2:15 PM


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