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Julian Pohlan, Denis Witham, Gloria Muench, Ho Jung Kwon, Elke Zimmermann, Marko Böhm, Damaris Praeger, Marc Dewey
Department of Radiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Luisenstraße 7, 10117 Berlin, Germany.
Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Mitte, Germany.
Clin Imaging. 2021 Jan;69:223-227. doi: 10.1016/j.clinimag.2020.09.004. Epub 2020 Sep 19.
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.
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.
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.
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.
败血症是指严重感染导致的器官功能障碍。脓毒症患者面临着较高的死亡风险。因此，及时识别并迅速确定焦点并加以控制至关重要。本研究旨在确定计算机断层扫描（CT）在败血症患者诊断中的当前作用。
我们在两年期间回顾性地在一家大型大学中心的急诊科中确定了 357 名疑似败血症的患者。共有 132 名患者在入院后 72 小时内行 CT 扫描。患者的临床和实验室检查结果进行了特征描述。对 CT 报告进行分类并与临床数据进行匹配。
在 357 名疑似败血症的急诊科患者中，37.0%（132/357）在 72 小时内行 CT 成像。CT 最常识别的感染灶为胸部（38.6%，49/127），腹部（22.0%，28/127）和泌尿生殖系统（20.5%，26/127），依次递减。每位患者的病灶检出率为 76.5%，同时扫描所需的患者人数为 1.31。在该患者人群中，CT 中使用造影剂并未提高病灶检出率（p=0.631）或诊断信心（p=0.432）。CT 对预测出院诊断的焦点具有 81.82%的阳性预测值（95%置信区间：76.31%至 86.28%）。在焦点不明确的患者中，随访影像学检查显示 39.5%的患者出现新的焦点。
我们对急诊科疑似败血症患者中 CT 作用的研究表明，CT 对出院诊断具有较高的阳性预测值。重复影像学检查可能有助于确定焦点持续不明确的亚组中进一步的感染灶。与预期相比，造影剂的使用对焦点检测的相关性较小，因为它并未增加诊断信心。
