Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

Pohlan, Julian; Witham, Denis; Muench, Gloria; Kwon, Ho Jung; Zimmermann, Elke; Böhm, M; Praeger, Damaris; Dewey, Marc

doi:10.1016/j.clinimag.2020.09.004

Cited by 11 publications

(11 citation statements)

References 22 publications

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“…A higher share of positive microbiological testing can be appreciated for definite foci on CT. Still, no significant association between different levels of confidence and associated microbiology findings was observed; chi-squared test with p = 0.32 with microbiology in patients with suspected sepsis in the emergency department [15]. The results of the current study suggest that CT and microbiological testing may have complementary roles as patients with a focus-negative CT may have a positive culture and vice versa [17].…”

Section: Discussioncontrasting

confidence: 53%

“…We previously provided a detailed analysis of the diagnostic yield of CT in septic ICU patients and investigated the role of CT in patients from the emergency department compared with patients treated in regular wards [14][15][16] Whereas common septic sources in surgical patients are known to include surgical site infections, imaging findings in patients from a medical ICU remain scarcely studied.…”

Section: Introductionmentioning

confidence: 99%

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Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study

et al. 2022

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Background Sepsis is a life-threatening condition that requires immediate focus identification and control. However, international sepsis guidelines do not provide information on imaging choice. Purpose To identify predictors of CT findings and patient outcomes in a population of septic patients from a medical ICU. Material and methods A full-text search in the radiological information system (RIS) retrieved 227 body CT examinations conducted to identify infectious sources in 2018. CT reports were categorized according to identified foci and their diagnostic certainty. Diagnostic accuracy of CT was compared to microbiological results. Clinical and laboratory information was gathered. Statistical analysis was performed using nonparametric tests and logistic regression analysis. Results CT revealed more positive infectious foci 52.4% (n = 191/227) than microbiological tests 39.3% (n = 79/201). There were no significant differences between focus-positive CT scans with regard to positive microbiological testing (p = 0.32). Sequential organ failure assessment (SOFA) scores were slightly but nonsignificantly higher in patients with a focus-positive CT, odds ratio (OR) = 0.999 (95% CI 0.997–1.001) with p = 0.52. Among C-reactive protein (CRP), procalcitonin (PCT), and leukocytes, in focus-positive versus focus-negative CT scans, CRP showed a minor but statistically significant elevation in the group with focus-positive CT scans (OR = 1.004, 95% CI = 1.000–1.007, p = 0.04). No significant association was found for PCT (OR = 1.007, 95% CI = 0.991–1.023; p = 0.40) or leukocytes (OR = 1.003, 95% CI = 0.970–1.038; p = 0.85). In 33.5% (n = 76/227) of cases, the CT findings had at least one therapeutic consequence. In 81.6% (n = 62/76), the CT findings resulted in one consequence, in 14.5% (n = 11/76) in two consequences, and in 3.9% (n = 3/76) in three consequences. There was no significant association between focus-positive CT scans and mortality (p = 0.81). Conclusion In this population of septic patients in medical intensive care, microbiological analysis complemented CT findings. Both clinical and laboratory parameters were not predictive of CT findings. While therapeutic consequences of CT findings in this study population underline the role of CT for decision making in septic patients, CT findings do not predict patient outcomes in this retrospective analysis.

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Section: Discussioncontrasting

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study

et al. 2022

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“…A full-text search for CT reports was conducted using the following key words: abscess, infection, fever, focus, infectious focus, search for focus, obscure focus, sepsis, urosepsis, and septic. Another analysis of data from 2018 with the same approach was previously published ( 16 – 18 ). As the query was designed to be broad, not all terms needed to be present.…”

Section: Methodsmentioning

confidence: 99%

“…Body CT has been shown to reliably identify infectious sources in septic patients ( 14 , 15 ). The authors previously conducted a detailed and systematic analysis of the role of CT for focus identification in sepsis in various hospital settings ( 16 – 18 ). Several studies have demonstrated a high diagnostic yield of non-contrast cranial CT (cCT) for cerebral pathologies including ischemic and/or hemorrhagic stroke ( 19 , 20 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebrovascular Events in Suspected Sepsis: Retrospective Prevalence Study in Critically Ill Patients Undergoing Full-Body Computed Tomography

et al. 2022

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PurposeThis study aimed at retrospectively evaluating full-body computed tomography (CT) examinations for the prevalence of cerebrovascular events in patients with suspected sepsis treated in the intensive care unit (ICU).MethodsAll full-body CT examinations, i.e., both cranial CT (cCT) and body CT including chest, abdomen and pelvis, for focus search in septic patients over a 12-months period were identified from three ICUs, using full-text search. From this retrospective cohort, we fully analyzed 278 cCT examinations for the occurrence of acute cerebral findings. All acute cerebrovascular events were independently reviewed by two blinded readers. Clinical and laboratory findings were extracted. The data were statistically analyzed using contingency tests.ResultsIn our population of patients with suspected sepsis, 10.8% (n = 30/278) were identified to have major cerebral events, including 7.2% (n = 20/278) major cerebrovascular events and 4.3% (n = 12/278) generalized parenchymal damage. 13.4% (n = 22/163) of patients with a severe coma as compared with non-severe coma, 4.4% (n = 3/68), showed a major cerebral event (p = 0.04). Patients referred from the cardiology/nephrology ICU ward showed major cerebral events in 16.3% (n = 22/135), as compared with 4.9% (n = 3/61) in patients from pulmonary ICU and 6.1% (n = 5/82) major cerebral events with surgical referral (p = 0.02).ConclusionOur study provides further evidence that septic patients may suffer from cerebral events with relevance to their prognosis. Severe coma and the referring ward were associated with acute cerebral conditions. Full-body CT has the advantage of both detecting of septic foci and possibly identifying ischemic or hemorrhagic stroke in this vulnerable patient population.

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“…CT is often used for detecting infectious sources or for imaging patients with unspecific symptoms (10). However, CT is less useful in diagnosing IVD damage.…”

Section: Introductionmentioning

confidence: 99%

Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom

et al. 2021

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Background Previously, dual-energy computed tomography (DECT) has been established for imaging spinal fractures as an alternative modality to magnetic resonance imaging (MRI). Purpose To analyze the diagnostic accuracy of DECT in visualizing intervertebral disc (IVD) damage. Material and Methods The lumbar spine of a Great Dane dog was used as an ex vivo biophantom. DECT was performed as sequential volume technique on a single-source CT scanner. IVDs were imaged before and after an injection of sodium chloride solution and after anterior discectomy in single-source sequential volume DECT technique using 80 and 135 kVp. Chondroitin/Collagen maps (cMaps) were reconstructed at 1 mm and compared with standard CT. Standardized regions of interest (ROI) were placed in the anterior anulus fibrosus, nucleus pulposus, and other sites. Three blinded readers classified all images as intact disc, nucleus lesion, or anulus lesion. Additionally, clinical examples from patients with IVD lesions were retrospectively identified from the radiological database. Results Interrater reliability was almost perfect with a Fleiss kappa of 0.833 (95% confidence interval [CI] 0.83–0.835) for DECT, compared with 0.780 (95% CI 0.778–0.782) for standard CT. For overall detection accuracy of IVD, DECT achieved 91.0% sensitivity (95% CI 83.6–95.8) and 92.0% specificity (95% CI 80.8–97.8). Standard CT showed 91.0% sensitivity (95% CI 83.6–95.8) and 78.0% specificity (95% CI 64.0–88.5). Conclusion DECT reliably identified IVD damage in an ex vivo biophantom. Clinical examples of patients with different lesions illustrate the accurate depiction of IVD microstructure. These data emphasize the diagnostic potential of DECT cMaps.

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Computed tomography for detection of septic foci: Retrospective analysis of patients presenting to the emergency department

Cited by 11 publications

References 22 publications

Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study

Body computed tomography in sepsis: predictors of CT findings and patient outcomes in a retrospective medical ICU cohort study

Cerebrovascular Events in Suspected Sepsis: Retrospective Prevalence Study in Critically Ill Patients Undergoing Full-Body Computed Tomography

Visualizing patterns of intervertebral disc damage with dual-energy computed tomography: assessment of diagnostic accuracy in an ex vivo spine biophantom

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