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Nøgleord
Infection
Imaging
Emergency medicine
Citation/Eksport
Resumé
Introduction: Chest radiography (CXR) is the first-choice imaging for diagnosing suspected infection in the emergency department (ED). However, previous descriptions of x-ray modalities are sparse. The objective was a) to describe CXR modalities in patients with suspected infection, findings, and image quality and b) investigate associations between patient characteristics and modalities.
Methods: In this secondary analysis of a prospective cohort study, we included ED patients with suspected infection and a CXR performed while admitted. We used binary regression to investigate which patient characteristics were associated with getting a sitting CXR (sitCXR) or supine CXR (supCXR).
Results: Out of 979 included patients, 60% were erect (eCXR), 15% were sitting (sitCXR), and 25% were supine CXR (supCXR). We observed a higher relative risk (RR; 95%CI) of having a sitCXR or supCXR if patients were 60–79 years or >80 years (2.3; 1.7–3.0 or 3.2; 2.5–4.3), had renal failure (1.5; 1.2–1.8), heart failure (1.4; 1.1–1.8), do-not-resuscitate/do-not-intubate-orders (2.5; 2.2–2.8), systolic blood pressure ≤100 mmHg (1.6; 1.3–1.9), respiratory rate ≥22 min (1.4; 1.2–1.6), and saturation <90% (1.6; 1.3–2.0).
Conclusion: SitCXR and supCXR are common in ED patients with suspected infection. Patients receiving sitCXR and supCXR were older, comorbid, and presented with abnormal vital signs.
Referencer
Cardinale L, Volpicelli G, Lamorte A, Martino J. Revisiting signs, strengths and weaknesses of Standard Chest Radiography in patients of Acute Dyspnea in the Emergency Department. J Thorac Dis. 2012;4(4):398-407. DOI: 10.3978/j.issn.2072-1439.2012.05.05
Broder J. Chapter 5 - Imaging the Chest: The Chest Radiograph. In: Broder J, editor. Diagnostic Imaging for the Emergency Physician. Saint Louis: W.B. Saunders; 2011. p. 185-296.
Mussmann B, Skov PM, Lorentzen MH, et al. Ultra-low-dose emergency chest computed tomography protocols in three vendors: A technical note. Acta Radiol Open. Mar 2023;12(3):20584601231183900. doi:10.1177/20584601231183900
Dansk lungemedicinsk selskab. Retningslinjer for håndtering af voksne patienter indlagt med pneumoni, 2021. https://lungemedicin.dk/wp-content/uploads/2022/01/DLS_DSI_Pneumoni_2021_110122_CPF.pdf (15. Maj 2024)
Dansk selskab for infektionsmedicin. Rekommandationer for initial behandling af sepsis og septisk shock, 2021. https://infmed.dk/site/tools/download.php?UID=f089404c228f4154d3b6343f83f4647041802db6 (15. maj 2024)
Kunz WG, Patzig M, Crispin A, Stahl R, Reiser MF, Notohamiprodjo M. The Value of Supine Chest X-Ray in the Diagnosis of Pneumonia in the Basal Lung Zones. Acad Radiol. 2018;25(10):1252-6. DOI: 10.1016/j.acra.2018.01.027
Kroft LJM, van der Velden L, Girón IH, Roelofs JJH, de Roos A, Geleijns J. Added Value of Ultra-low-dose Computed Tomography, Dose Equivalent to Chest X-Ray Radiography, for Diagnosing Chest Pathology. J Thorac Imaging. 2019;34(3):179-86. DOI: 10.1097/RTI.0000000000000404
Self WH, Courtney DM, McNaughton CD, Wunderink RG, Kline JA. High discordance of chest x-ray and computed tomography for detection of pulmonary opacities in ED patients: implications for diagnosing pneumonia. Am J Emerg Med. 2013;31(2):401-5. DOI: 10.1016/j.ajem.2012.08.041
Studler U, Kretzschmar M, Christ M, Breidthardt T, Noveanu M, Schoetzau A, et al. Accuracy of chest radiographs in the emergency diagnosis of heart failure. Eur Radiol. 2008;18(8):1644-52. 10.1007/s00330-008-0930-0
Esayag Y, Nikitin I, Bar-Ziv J, Cytter R, Hadas-Halpern I, Zalut T, et al. Diagnostic value of chest radiographs in bedridden patients suspected of having pneumonia. Am J Med. 2010;123(1):88 e1-5. DOI: 10.1016/j.amjmed.2009.09.012
Hayden GE, Wrenn KW. Chest radiograph vs. computed tomography scan in the evaluation for pneumonia. J Emerg Med. 2009;36(3):266-70. DOI: 10.1016/j.jemermed.2007.11.042
Hagaman JT, Rouan GW, Shipley RT, Panos RJ. Admission chest radiograph lacks sensitivity in the diagnosis of community-acquired pneumonia. Am J Med Sci. 2009;337(4):236-40. DOI: 10.1097/MAJ.0b013e31818ad805
Cipollini F, Mirauta CM. Bedside lung ultrasound in the diagnosis of pneumonia in very old patients. Ital J Med. 2018;12(2):126-30. DOI: 10.4081/itjm.2018.981
Syrjala H, Broas M, Suramo I, Ojala A, Lahde S. High-resolution computed tomography for the diagnosis of community-acquired pneumonia. Clin Infect Dis. 1998;27(2):358-63. DOI: 10.1086/514675
Ibrahim D, Bizri AR, El Amine MA, Halabi Z. Chest computed tomography and chest X-ray in the diagnosis of community-acquired pneumonia: a retrospective observational study. J Int Med Res. 2021;49(8):3000605211039791. DOI: 10.1177/03000605211039791
Mueller-Lenke N, Rudez J, Staub D, Laule-Kilian K, Klima T, Perruchoud AP, et al. Use of chest radiography in the emergency diagnosis of acute congestive heart failure. Heart. 2006;92(5):695-6. DOI: 10.1136/hrt.2005.074583
Gezer NS, Balcı P, Tuna K, Akın IB, Barış MM, Oray N. Utility of chest CT after a chest X-ray in patients presenting to the ED with non-traumatic thoracic emergencies. Am J Emerg Med. 2017;35(4):623-7. DOI: 10.1016/j.ajem.2016.12.058
Claessens Y-E, Debray M-P, Tubach F, Brun A-L, Rammaert B, Hausfater P, et al. Early Chest Computed Tomography Scan to Assist Diagnosis and Guide Treatment Decision for Suspected Community-acquired Pneumonia. Am J Respir Crit Care Med. 2015;192(8):974-82. DOI: 10.1164/rccm.201501-0017OC
Tækker M, Kristjánsdóttir B, Andersen MB, Fransen ML, Greisen PW, Laursen CB, et al. Diagnostic accuracy of ultra-low-dose chest computed tomography in an emergency department. Acta Radiol. 2021:284185121995804. DOI: 10.1177/0284185121995804
Jessen MK, Andersen LW, Thomsen MLH, Jensen ME, Kirk ME, Kildegaard S, et al. Twenty-four-hour fluid administration in emergency department patients with suspected infection: A multicenter, prospective, observational study. Acta Anaesthesiol Scand. 2021;65(8):1122-42. DOI: 10.1111/aas.13848
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. Mar 1977;33(1):159-74. DOI: 10.2307/2529310
Tocino I. Chest imaging in the intensive care unit. Eur J Radiol. 1996;23(1):46-57. DOI: 10.1016/0720-048x(96)88279-9
Ticinesi A, Lauretani F, Nouvenne A, Mori G, Chiussi G, Maggio M, et al. Lung ultrasound and chest x-ray for detecting pneumonia in an acute geriatric ward. Medicine (Baltimore). 2016;95(27):e4153. DOI: 10.1097/md.0000000000004153
Brabrand M, Kellett J, Opio M, Cooksley T, Nickel CH. Should impaired mobility on presentation be a vital sign? Acta Anaesthesiol Scand. 2018;62(7):945-52. DOI: 10.1111/aas.13098
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