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Multicenter Study
. 2018 Mar;153(3):601-610.
doi: 10.1016/j.chest.2017.07.035. Epub 2017 Aug 9.

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes

Cameron P Upchurch  1 , Carlos G Grijalva  2 , Richard G Wunderink  3 , Derek J Williams  4 , Grant W Waterer  5 , Evan J Anderson  6 , Yuwei Zhu  7 , Eric M Hart  8 , Frank Carroll  9 , Anna M Bramley  10 , Seema Jain  10 , Kathryn M Edwards  4 , Wesley H Self  11
Affiliations
Multicenter Study

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes

Cameron P Upchurch et al. Chest. 2018 Mar.

Abstract

Background: The clinical significance of pneumonia visualized on CT scan in the setting of a normal chest radiograph is uncertain.

Methods: In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens present, and outcomes of patients with pneumonia visualized on a CT scan but not on a concurrent chest radiograph (CT-only pneumonia) and those with pneumonia visualized on a chest radiograph. All patients underwent chest radiography; the decision to obtain CT imaging was determined by the treating clinicians. Chest radiographs and CT images were interpreted by study-dedicated thoracic radiologists blinded to the clinical data.

Results: The study population included 2,251 adults with CAP; 2,185 patients (97%) had pneumonia visualized on chest radiography, whereas 66 patients (3%) had pneumonia visualized on CT scan but not on concurrent chest radiography. Overall, these patients with CT-only pneumonia had a clinical profile similar to those with pneumonia visualized on chest radiography, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial (12% vs 14%) pathogens, ICU admission (23% vs 21%), use of mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and inhospital mortality (0 vs 2%).

Conclusions: Adults hospitalized with CAP who had radiological evidence of pneumonia on CT scan but not on concurrent chest radiograph had pathogens, disease severity, and outcomes similar to patients who had signs of pneumonia on chest radiography. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography.

Keywords: CT scan; chest radiography; pneumonia.

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Figure 1
Figure 1
Flow diagram for generation of the study population.
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References

    1. Kochanek K.D., Murphy S.L., Xu J., Tejada-Vera B. Death: Final data for 2014. Natl Vital Stat Rep. 2016;64(2):1–119. - PubMed
    1. Centers for Disease Control and Prevention. Number and rate of discharges from short-stay hospitals and days of care, with average length of stay and standard error, by selected first-listed diagnostic categories: United States, 2010. https://www.cdc.gov/nchs/data/nhds/2average/2010ave2_firstlist.pdf. Accessed July 27, 2017.
    1. Self W.H., Grijalva C.G., Zhu Y. Rates of emergency department visits due to pneumonia in the United States, July 2006-June 2009. Acad Emerg Med. 2013;20(9):957–960. - PMC - PubMed
    1. Mandell L.A., Wunderink R.G., Anzueto A. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(suppl 2):S27–S72. - PMC - PubMed
    1. Kocher K.E., Meurer W.J., Fazel R., Scott P.A., Krumholz H.M., Nallamothu B.K. National trends in use of computed tomography in the emergency department. Ann Emerg Med. 2011;58(5):452–462. - PubMed

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