Community-acquired pneumonia in the emergency department: an algorithm to facilitate diagnosis and guide chest CT scan indication.
Aged
Aged, 80 and over
Algorithms
Biomarkers
Clinical Decision-Making
Community-Acquired Infections
/ diagnosis
Disease Management
Emergency Medical Services
/ statistics & numerical data
Emergency Service, Hospital
Female
Humans
Male
Middle Aged
Pneumonia
/ diagnosis
Public Health Surveillance
Radiography, Thoracic
Sensitivity and Specificity
Tomography, X-Ray Computed
/ methods
Chest CT scan
Community-acquired pneumonia
Diagnosis
Diagnostic methods
Emergency department
Polymerase chain reaction
Respiratory viruses
Journal
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases
ISSN: 1469-0691
Titre abrégé: Clin Microbiol Infect
Pays: England
ID NLM: 9516420
Informations de publication
Date de publication:
Mar 2020
Mar 2020
Historique:
received:
25
03
2019
revised:
12
06
2019
accepted:
17
06
2019
pubmed:
10
7
2019
medline:
2
10
2020
entrez:
9
7
2019
Statut:
ppublish
Résumé
The aim was to create and validate a community-acquired pneumonia (CAP) diagnostic algorithm to facilitate diagnosis and guide chest computed tomography (CT) scan indication in patients with CAP suspicion in Emergency Departments (ED). We performed an analysis of CAP suspected patients enrolled in the ESCAPED study who had undergone chest CT scan and detection of respiratory pathogens through nasopharyngeal PCRs. An adjudication committee assigned the final CAP probability (reference standard). Variables associated with confirmed CAP were used to create weighted CAP diagnostic scores. We estimated the score values for which CT scans helped correctly identify CAP, therefore creating a CAP diagnosis algorithm. Algorithms were externally validated in an independent cohort of 200 patients consecutively admitted in a Swiss hospital for CAP suspicion. Among the 319 patients included, 51% (163/319) were classified as confirmed CAP and 49% (156/319) as excluded CAP. Cough (weight = 1), chest pain (1), fever (1), positive PCR (except for rhinovirus) (1), C-reactive protein ≥50 mg/L (2) and chest X-ray parenchymal infiltrate (2) were associated with CAP. Patients with a score below 3 had a low probability of CAP (17%, 14/84), whereas those above 5 had a high probability (88%, 51/58). The algorithm (score calculation + CT scan in patients with score between 3 and 5) showed sensitivity 73% (95% CI 66-80), specificity 89% (95% CI 83-94), positive predictive value (PPV) 88% (95% CI 81-93), negative predictive value (NPV) 76% (95% CI 69-82) and area under the curve (AUC) 0.81 (95% CI 0.77-0.85). The algorithm displayed similar performance in the validation cohort (sensitivity 88% (95% CI 81-92), specificity 72% (95% CI 60-81), PPV 86% (95% CI 79-91), NPV 75% (95% CI 63-84) and AUC 0.80 (95% CI 0.73-0.87). Our CAP diagnostic algorithm may help reduce CAP misdiagnosis and optimize the use of chest CT scan.
Identifiants
pubmed: 31284034
pii: S1198-743X(19)30377-5
doi: 10.1016/j.cmi.2019.06.026
pii:
doi:
Substances chimiques
Biomarkers
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
382.e1-382.e7Investigateurs
Y E Claessens
(YE)
X Duval
(X)
E Bouvard
(E)
M F Carette
(MF)
M P Debray
(MP)
C Mayaud
(C)
C Leport
(C)
N Houhou
(N)
S Tubiana
(S)
M Benjoar
(M)
F X Blanc
(FX)
A L Brun
(AL)
L Epelboin
(L)
C Ficko
(C)
A Khalil
(A)
H Lefloch
(H)
J M Naccache
(JM)
B Rammaert
(B)
A Abry
(A)
J C Allo
(JC)
S Andre
(S)
C Andreotti
(C)
N Baarir
(N)
M Bendahou
(M)
L Benlafia
(L)
J Bernard
(J)
A Berthoumieu
(A)
M E Billemont
(ME)
J Bokobza
(J)
A L Brun
(AL)
E Burggraff
(E)
P Canavaggio
(P)
M F Carette
(MF)
E Casalino
(E)
S Castro
(S)
C Choquet
(C)
H Clément
(H)
L Colosi
(L)
A Dabreteau
(A)
S Damelincourt
(S)
S Dautheville
(S)
M P Debray
(MP)
M Delay
(M)
S Delerme
(S)
L Depierre
(L)
F Djamouri
(F)
F Dumas
(F)
M R S Fadel
(MRS)
A Feydey
(A)
Y Freund
(Y)
L Garcia
(L)
H Goulet
(H)
P Hausfater
(P)
E Ilic-Habensus
(E)
M O Josse
(MO)
J Kansao
(J)
Y Kieffer
(Y)
F Lecomte
(F)
K Lemkarane
(K)
P Madonna
(P)
O Meyniard
(O)
L Mzabi
(L)
D Pariente
(D)
J Pernet
(J)
F Perruche
(F)
J M Piquet
(JM)
R Ranerison
(R)
P Ray
(P)
F Renai
(F)
E Rouff
(E)
D Saget
(D)
K Saïdi
(K)
G Sauvin
(G)
E Trabattoni
(E)
N Trimech
(N)
C Auger
(C)
B Pasquet
(B)
S Tamazirt
(S)
J M Treluyer
(JM)
F Tubach
(F)
J Wang
(J)
O Chassany
(O)
C Misse
(C)
Informations de copyright
Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.