Low-dose computed tomography for the diagnosis of pneumonia in elderly patients: a prospective, interventional cohort study

Abstract

The diagnosis of pneumonia is challenging. Our objective was to assess whether low-dose computed tomography (LDCT) modified the probability of diagnosing pneumonia in elderly patients.We prospectively included patients aged over 65 years with a suspicion of pneumonia treated with antimicrobial therapy (AT). All patients had a chest radiograph and LDCT within 72 h of inclusion. The treating clinician assessed the probability of pneumonia before and after the LDCT scan using a Likert scale. An adjudication committee retrospectively rated the probability of pneumonia and was considered as the reference for diagnosis. The main outcome was the difference in the clinician's pneumonia probability estimates before and after LDCT and the proportion of modified diagnoses which matched the reference diagnosis (the net reclassification improvement (NRI)).A total of 200 patients with a median age of 84 years were included. After LDCT, the estimated probability of pneumonia changed in 90 patients (45%), of which 60 (30%) were downgraded and 30 (15%) were upgraded. The NRI was 8% (NRI event (−6%) + NRI non-event (14%)).LDCT modified the estimated probability of pneumonia in a substantial proportion of patients. It mostly helped to exclude a diagnosis of pneumonia and hence to reduce unnecessary AT.

Accuracy of C-reactive protein, procalcitonin, serum amyloid A and neopterin for low-dose CT-scan confirmed pneumonia in elderly patients: A prospective cohort study

“…This is a diagnostic study nested in a prospective observational cohort. Consecutive patients older than 65 years and hospitalized with suspected pneumonia in Geneva University Hospitals, a 1800-bed tertiary-care hospital, were eligible [5]. Patients had at least one respiratory…”

“…symptom or sign and one symptom, sign, or laboratory finding suggestive of acute infection, with a working diagnosis of pneumonia warranting antibiotic treatment [5]. The choice and duration of antibiotic treatment were at the discretion of the treating physician.…”

Accuracy of comprehensive PCR analysis of nasopharyngeal and oropharyngeal swabs for CT-scan-confirmed pneumonia in elderly patients: a prospective cohort study

“…The radiologists were blinded to participants' clinical, biological and microbiological results, so incorporation bias could be attenuated. According to recent findings, a reference standard for pneumonia based on chest X-ray may lead to frequent misclassifications, which can flaw the evaluation of microbiological test accuracy [10,27]. Our comprehensive molecular testing included more respiratory bacterial pathogens than previous works [6,7].…”

“…A chest low-dose computed tomography scan (LDCT) was performed as soon as possible. Results regarding the diagnostic performance of LDCT have been published elsewhere [10]. The present study is a preplanned secondary analysis evaluating the accuracy of comprehensive molecular testing in patients with suspected pneumonia.…”

“…Consecutive hospitalized individuals 65 years old, suspected of having community-, nursing-home-or hospital-acquired pneumonia were enrolled between 1 May 2015 and 30 April 2016. Individuals included had at least one respiratory symptom and at least one symptom or laboratory finding compatible with infection [10]. Individuals treated for pneumonia during the previous 6 months or treated with antimicrobial therapy for more than 48 h before inclusion were excluded ( Fig.…”