Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis
<i>Background and Objectives:</i> Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT)....
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-08-01
|
| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/59/9/1508 |
| _version_ | 1797578925610631168 |
|---|---|
| author | Sabrina Kepka Charlène Heimann François Severac Louise Hoffbeck Pierrick Le Borgne Eric Bayle Yvon Ruch Joris Muller Catherine Roy Erik André Sauleau Emmanuel Andres Mickaël Ohana Pascal Bilbault |
| author_facet | Sabrina Kepka Charlène Heimann François Severac Louise Hoffbeck Pierrick Le Borgne Eric Bayle Yvon Ruch Joris Muller Catherine Roy Erik André Sauleau Emmanuel Andres Mickaël Ohana Pascal Bilbault |
| author_sort | Sabrina Kepka |
| collection | DOAJ |
| description | <i>Background and Objectives:</i> Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. <i>Materials and Methods:</i> We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. <i>Results:</i> Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). <i>Conclusion:</i> There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS. |
| first_indexed | 2024-03-10T22:28:36Z |
| format | Article |
| id | doaj.art-012934d26727474786f390962291ff5c |
| institution | Directory Open Access Journal |
| issn | 1010-660X 1648-9144 |
| language | English |
| last_indexed | 2024-03-10T22:28:36Z |
| publishDate | 2023-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-012934d26727474786f390962291ff5c2023-11-19T11:50:53ZengMDPI AGMedicina1010-660X1648-91442023-08-01599150810.3390/medicina59091508Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective AnalysisSabrina Kepka0Charlène Heimann1François Severac2Louise Hoffbeck3Pierrick Le Borgne4Eric Bayle5Yvon Ruch6Joris Muller7Catherine Roy8Erik André Sauleau9Emmanuel Andres10Mickaël Ohana11Pascal Bilbault12Emergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, FranceEmergency Department, Hôpital Emile Muller, 20 rue du Dr Laennec, 68100 Mulhouse, FranceICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, FranceEmergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, FranceEmergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, FranceEmergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, FranceDepartment of Infectious and Tropical Diseases, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, FrancePublic Health Units, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, FranceRadiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, FranceICUBE, UMR 7357, CNRS, 300 Bd Sébastien Brant, 67400 Illkirch-Graffenstaden, FranceDepartment of Internal Medicine, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, FranceRadiology Department, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, 67091 Strasbourg, FranceEmergency Department, Hôpitaux Universitaires de Strasbourg, 1 Place de l’Hôpital, CHRU of Strasbourg, 67091 Strasbourg, France<i>Background and Objectives:</i> Chest radiography remains the most frequently used examination in emergency departments (ED) for the diagnosis of community-acquired pneumonia (CAP), despite its poor diagnostic accuracy compared with ultra-low-dose (ULD) chest computed tomography (CT). However, although ULD CT appears to be an attractive alternative to radiography, its organizational impact in ED remains unknown. Our objective was to compare the relevant timepoints in ED management of CT and chest radiography. <i>Materials and Methods:</i> We conducted a retrospective study in two ED of a University Hospital including consecutive patients consulting for a CAP between 1 March 2019 and 29 February 2020 to assess the organizational benefits of ULD chest CT and chest radiography (length of stay (LOS) in the ED, time of clinical decision after imaging). Overlap weights (OW) were used to reduce covariate imbalance between groups. <i>Results:</i> Chest radiography was performed for 1476 patients (mean age: 76 years [63; 86]; 55% men) and ULD chest CT for 133 patients (mean age: 71 [57; 83]; 53% men). In the weighted population with OW, ULD chest CT did not significantly alter the ED LOS compared with chest radiography (11.7 to 12.2; MR 0.96 [0.85; 1.09]), although it did significantly reduce clinical decision time (6.9 and 9.5 h; MR 0.73 [0.59; 0.89]). <i>Conclusion:</i> There is real-life evidence that a strategy with ULD chest CT can be considered to be a relevant approach to replace chest radiography as part of the diagnostic workup for CAP in the ED without increasing ED LOS.https://www.mdpi.com/1648-9144/59/9/1508community-acquired pneumoniaultra-low-dose chest computed tomographychest radiographyemergency department |
| spellingShingle | Sabrina Kepka Charlène Heimann François Severac Louise Hoffbeck Pierrick Le Borgne Eric Bayle Yvon Ruch Joris Muller Catherine Roy Erik André Sauleau Emmanuel Andres Mickaël Ohana Pascal Bilbault Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis Medicina community-acquired pneumonia ultra-low-dose chest computed tomography chest radiography emergency department |
| title | Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis |
| title_full | Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis |
| title_fullStr | Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis |
| title_full_unstemmed | Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis |
| title_short | Organizational Benefits of Ultra-Low-Dose Chest CT Compared to Chest Radiography in the Emergency Department for the Diagnostic Workup of Community-Acquired Pneumonia: A Real-Life Retrospective Analysis |
| title_sort | organizational benefits of ultra low dose chest ct compared to chest radiography in the emergency department for the diagnostic workup of community acquired pneumonia a real life retrospective analysis |
| topic | community-acquired pneumonia ultra-low-dose chest computed tomography chest radiography emergency department |
| url | https://www.mdpi.com/1648-9144/59/9/1508 |
| work_keys_str_mv | AT sabrinakepka organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT charleneheimann organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT francoisseverac organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT louisehoffbeck organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT pierrickleborgne organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT ericbayle organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT yvonruch organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT jorismuller organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT catherineroy organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT erikandresauleau organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT emmanuelandres organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT mickaelohana organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis AT pascalbilbault organizationalbenefitsofultralowdosechestctcomparedtochestradiographyintheemergencydepartmentforthediagnosticworkupofcommunityacquiredpneumoniaarealliferetrospectiveanalysis |