Scientific article
Open access

Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies

Published inJournal of Clinical Medicine, vol. 8, no. 4, 514
Publication date2019

Diagnosing pneumonia in emergency departments is challenging because the accuracy of symptoms, signs and laboratory tests is limited. As a confirmation test, chest X-ray has significant limitations and is outperformed by CT-scan. However, obtaining a CT-scan in all cases of suspected pneumonia has significant drawbacks. We used a cohort of 200 consecutive elderly patients admitted to the hospital for suspected pneumonia to build a simple prediction score, which was used to determine indication for performing a CT-scan. The reference diagnosis was adjudicated by experts considering all available data, including evolution until discharge and CT scan in all patients. Results were externally validated in a second cohort of 319 patients. Pneumonia was confirmed in 133 patients (67%). Area under the receiver operator curve (AUROC) of physician evaluation was 0.55 (0.46-0.64). The score incorporated four variables independently predicting confirmed pneumonia: male gender, acute cough, C-reactive protein >70 mg/L, and urea <7 mmol/L. AUROC of the score was 0.68 (95% confidence interval (CI) 0.60-0.76). When a CT-scan was obtained for patients at low or intermediate predicted risk (108 patients, 54% of the cohort), AUROC was 0.71 (0.63-0.80) and 0.69 (0.64-0.74) in the derivation and validation cohort, respectively. A simple prediction score for pneumonia had moderate accuracy and could guide the performance of a CT-scan.

  • CT-scan
  • Clinical prediction model
  • Lower respiratory tract infection
Citation (ISO format)
GARIN, Nicolas et al. Rational Use of CT-Scan for the Diagnosis of Pneumonia: Comparative Accuracy of Different Strategies. In: Journal of Clinical Medicine, 2019, vol. 8, n° 4, p. 514. doi: 10.3390/jcm8040514
Main files (1)
Article (Published version)
ISSN of the journal2077-0383

Technical informations

Creation10/19/2020 7:21:00 PM
First validation10/19/2020 7:21:00 PM
Update time03/15/2023 11:29:37 PM
Status update03/15/2023 11:29:37 PM
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