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A5522 - The Utility of Chest CT Imaging in Pneumonia: Over Utilization and Limited Value of CT Thorax Imaging in Pneumonia
Author Block: M. Shahzadi1, V. P. Vasudevan2, L. N. Gerolemou3, F. Arjomand4, A. Z. Rasheed5, Z. Hashemi6, M. K. Sarwar7; 1Pulmonology, The Brooklyn Hospital Center, Brooklyn, NY, United States, 2Pulmonary Division, Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States, 3The Brooklyn Hospital Center, Brooklyn, NY, United States, 4Brooklyn Hosp Ctr, Brooklyn, NY, United States, 5Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States, 6Pulmonary, The Brooklyn Hospital Center, Brooklyn, NY, United States, 7Internal Medicine, Brooklyn, NY, United States.
RATIONALE: Pneumonia is a common diagnosis among hospitalized patients. The diagnosis is based on clinical suspicion and its confirmation with Chest x-ray. CT scan of thorax is a superior imaging study as it reveals occult infiltrate or mass, characterizes its location, and can find mediastinal pathology and pleural effusion. CT image pattern recognition is useful in narrowing the differential diagnoses and helps guide management decisions i.e. selection of antimicrobials and planning further diagnostics procedures like fiber-optic bronchoscopy, thoracentesis or mediastincoscopy. However, CT imaging is costly and exposes patients to risks of radiation and exposure to radiocontrast agents i.e. allergy and contrast nephropathy. Hence, CT thorax should be ordered selectively in patients where the benefits outweigh harm and is cost-effective. METHODS: This observational non-interventional study was conducted by the pulmonary division, Department of Internal medicine at The Brooklyn Hospital Center. We conducted a retrospective chart review of all inpatients who were diagnosed with pneumonia between January 01, 2009 and August 31st 2013.We reviewed patient demographics, clinical presentation, reports of CXR and CT chest, and outcome of patients. RESULTS: 156 patients were included in this study. Out of 156, 70(44%) were male; 86(55%) were female. Mean age was 60-69 years. Out of 156, 103(66%) had pneumonia, 12(7%) had dyspnea, 6(3%) had obstructive pulmonary disease, 4(2%) had sickle cell disease, 3(1%) had immunosuppression, 12(7%) had chest pain, 5(3%) had congestive heart failure. Out of 156, CT scan was ordered appropriately only in 28(17%) patients; 7(4%) had bronchoscopy with BAL +/- biopsy; 3(2%) had CT guided biopsy for lung mass which showed adenocarcinoma; 5(3%) had chest tube placement for pneumothorax and large pleural effusion; 8(5%) were intubated for respiratory failure secondary to septic shock and bacteremia; 4(2%) required thoracocentesis for parapneumonic effusion. Out of 156, 102(65%) patients had portable chest x-ray which led to CT scan of chest. There were no untoward reactions to contrast. CONCLUSION: We concluded that CT scanning in our institution was over-utilized in the setting of pneumonia. We found that additional CT imaging bore little to no impact on management decisions with respect to the pneumonia itself. In few instances, incidental findings, such as masses or small effusions, were identified, but had minimal clinical significance. In analyzing our patterns of chest CT use, we can begin to develop and further refine chest CT imaging protocols in decisions for infectious processes.