Julian Pohlan1, Denis Witham2, Gloria Muench3, Ho Jung Kwon3, Elke Zimmermann3, Marko Böhm4, Damaris Praeger2, Marc Dewey3. 1. Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Luisenstraße 7, 10117 Berlin, Germany. Electronic address: julian.pohlan@charite.de. 2. Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Germany. 3. Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Luisenstraße 7, 10117 Berlin, Germany. 4. Emergency department, Charité - Universitätsmedizin Berlin, Campus Mitte, Germany.
Abstract
OBJECTIVE: Sepsis is defined as organ dysfunction due to severe infection. Septic patients face a significant mortality risk. Thus, timely recognition with prompt focus identification and control are essential. This study aims to determine the current role of computed tomography (CT) in the diagnostic workup of septic patients. METHODS: We retrospectively identified 357 patients in the emergency department (ED) of a large university center with suspected sepsis in a two-year period. A total of 132 patients underwent CT scanning within 72 h of admission. Patients were characterized by clinical and laboratory findings. CT reports were categorized and matched with clinical data. RESULTS: Of 357 ED patients with suspected sepsis, 37.0% (132/357) underwent CT imaging within 72 h. The most commonly identified septic foci in CT were chest 38.6% (49/127), abdomen 22.0% (28/127) and genitourinary tract 20.5% (26/127) in descending order. The focus detection rate was 76.5% per patient with a concurrent number-needed-to-scan of 1.31. Contrast medium administration in CT did not improve focus detection rate (p = 0.631) or diagnostic confidence in this patient population (p = 0.432). CT had a positive predictive value of 81.82% (CI 76.31 to 86.28%) in predicting the focus of the discharge diagnosis. Follow-up imaging in patients with unclear focus reveals a new focus in 39.5% of patients. CONCLUSIONS: Our investigation of the role of CT in ED patients with suspected sepsis indicated a high positive predictive value for CT with regard to the discharge diagnosis. Repeat imaging may help identify further septic foci in a subgroup with persistently unclear focus. Use of contrast medium seems less relevant for focus detection than expected, as it did not increase diagnostic confidence.
OBJECTIVE:Sepsis is defined as organ dysfunction due to severe infection. Septic patients face a significant mortality risk. Thus, timely recognition with prompt focus identification and control are essential. This study aims to determine the current role of computed tomography (CT) in the diagnostic workup of septic patients. METHODS: We retrospectively identified 357 patients in the emergency department (ED) of a large university center with suspected sepsis in a two-year period. A total of 132 patients underwent CT scanning within 72 h of admission. Patients were characterized by clinical and laboratory findings. CT reports were categorized and matched with clinical data. RESULTS: Of 357 ED patients with suspected sepsis, 37.0% (132/357) underwent CT imaging within 72 h. The most commonly identified septic foci in CT were chest 38.6% (49/127), abdomen 22.0% (28/127) and genitourinary tract 20.5% (26/127) in descending order. The focus detection rate was 76.5% per patient with a concurrent number-needed-to-scan of 1.31. Contrast medium administration in CT did not improve focus detection rate (p = 0.631) or diagnostic confidence in this patient population (p = 0.432). CT had a positive predictive value of 81.82% (CI 76.31 to 86.28%) in predicting the focus of the discharge diagnosis. Follow-up imaging in patients with unclear focus reveals a new focus in 39.5% of patients. CONCLUSIONS: Our investigation of the role of CT in ED patients with suspected sepsis indicated a high positive predictive value for CT with regard to the discharge diagnosis. Repeat imaging may help identify further septic foci in a subgroup with persistently unclear focus. Use of contrast medium seems less relevant for focus detection than expected, as it did not increase diagnostic confidence.
Authors: Julian Pohlan; Jawed Nawabi; Denis Witham; Luna Schroth; Finn Krause; Jan Schulze; Simon Gelen; Robert Ahlborn; Kerstin Rubarth; Marc Dewey Journal: Front Neurol Date: 2022-05-09 Impact factor: 4.086